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THE  LIBRARY 

OF 

THE  UNIVERSITY 

OF  CALIFORNIA 

LOS  ANGELES 


WAR  CORRESPONDENCE 

{HISPANO  AMERICAN  WAR) 


LETTERS   FROM 


DR.    NICHOLAS    SENN 

CHIEF   SURGEON   U.S.    VOLUNTEERS. 
CHIEF  OF   OPERATING   STAFF  WITH   THE   ARMY  IN   THE   FIELD. 


REPRINTED  FROM  THE 
JOURNAL  OF  THE  AMERICAN  MEDICAL  ASSOCIATION. 


CHICAGO: 

American  Medical  Association  Press. 

1899. 


Library 


CONTENTS, 


War  Correspondence 1 

An  Old  Battle  Ground 24 

Letter  from  Camp  George  H.  Thomas 31 

Assigned  to  a  New  Field 41 

The  Floating  Hospitals 50 

The  Medical  Department  of  the  Army  in  the  Cuban  Cam- 
paign  55 

The  Qualifications  and  Duties  of  the  Military  Surgeon  .    .    61 
The  Invasion  of  Porto  Rico  from  a  Medical  Standpoint  .    .    79 

Typhoid  Fever  in  the  Porto  Rican  Campaign 95 

The  Returning  Army 101 

The  National  Cry 108 

Our  Relief  Societies 115 

The  Wounded  of  the  Porto  Rican  Campaign 122 

On  the  Frequency  of  Cryptorchism  and  its  Results  ....  131 

The  Seat  of  War  and  our  Military  Surgeons 133 

Headquarters  Fifth  Army  Corps 138 

Recent  Experiences  in  Military  Surgery  after  the  Battle  of 

Santiago 146 

The  Surgery  of  Camp  Wikoff 183 

Empyema  in  Camp  George  H.  Thomas 237 

Esculapius  on  the  Field  of  Battle  . 255 

Nurses  and  Nursing  in  War 265 


WAR   CORRESPONDENCE. 


The  beating  of  the  drum,  the  measured  tread  of  an  armed 
host  are  again  heard  throughout  the  land  and  have  aroused 
the  patriotic  spirit  of  the  American  people.  For  a  fifth  time 
our  nation  is  face  to  face  with  a  war  the  gravity  of  which  it  is 
impossible  to  estimate  at  the  present  time.  The  first  war 
brought  us  our  liberty  and  independence ;  the  second  estab- 
lished our  reputation  on  the  sea  ;  the  third  taught  our  Mexican 
neighbor  respect  for  our  country  ;  the  fourth  saved  the  Union, 
and  the  fifth,  which  is  now  being  waged,  was  provoked  in  the 
cause  of  humanity. 

For  centuries  the  beautiful  neighboring  island  of  Cuba  has 
been  in  the  greedy  grasp  of  a  foreign  nation.  The  people  to 
whom  this  gem  of  the  ocean  belongs  have  been  downtrodden, 
tyrannized  over  and  abused  by  the  cold  iron  hand  of  an  effete 
monarchy.  The  humane  liberty-loving  people  of  the  United 
States  have  heard  the  cry  of  the  oppressed  starving  Cubans 
for  years,  and  have  done  all  in  their  power,  short  of  resort  to 
the  sword,  to  relieve  their  sufferings,  but  without  avail.  The 
ear  of  the  proud,  cowardly  Spainard  remained  deaf  to  well- 
meant  and  most  earnest  appeals.  The  Chief  Executive  of  the 
United  States  exhausted  every  resource  to  improve  the  condi- 
tion of  the  native  Cubans,  the  rightful  owners  of  the  unfor- 
tunate island,  without  bloodshed,  but  all  his  efforts  were 
ignored  and  antagonized  by  the  brutal  oppressors. 

War  is  always  a  great  calamity,  but  when  entered  upon  for 
the  sake  of  humanity,  for  the  relief  of  the  oppressed,  it  becomes 
a  weapon  in  the  hand  of  the  Almighty.  The  issue  before  us  is 
a  righteous  one,  and  it  is  not  difficult  to  forecast  the  ultimate 
result.  Justice  and  humanity  are  on  our  side  ;  corruption  and 
oppression  on  the  other.  On  our  part  the  struggle  is  purely 
unselfish ;  on  the  other  it  is  a  desperate  but  vain  attempt  to 
ignore  the  claims  of  an  enslaved  people.  Such  are  the  condi- 
tions of  the  present  war  with  Spain,  at  the  same  time  our  peo- 
ple will  now  and  for  all  time  come  "Remember  the  Maine." 


The  war  has  begun,  the  deafening  roar  of  cannon  has  been 
heard  in  different  Spanish  ports,  the  hero  of  Manila  has  planted 
the  Stars  and  Stripes,  the  emblem  of  liberty  and  equality,  on 
the  shores  of  the  distant  Philippine  Islands ;  there  it  will 
remain  until  the  unhappy  inhabitants  breathe  the  bracing  air 
of  independence.  No  war  was  ever  undertaken  in  which  the 
government  had  such  a  firm  and  enthusiastic  support  from  the 
mass  of  the  people  regardless  of  politics,  religion,  nationality 
and  position  in  life. 

The  policy  laid  out,  advised  and  carried  in  effect  by  President 
McKinley,  meets  with  the  undivided  support  of  the  reunited 
nation.  The  gray  is  eager  and  anxious  to  don  the  blue  in  his 
country's  cause.  Federal  and  Confederate  meet  again  to  talk 
over  the  memories  of  the  past  at  a  common  camp  fire  during 
the  campaign  against  a  common  foe,  who  has  been  permitted 
far  too  long  a  time  to  abstract  the  life  blood  of  an  innocent 
people,  the  legitimate  owners  of  one  of  God's  most  beautiful 
islands  so  close  to  our  own  great,  forever  free  and  united 
country. 

ILLINOIS    ARMY. 

Illinois  has  always  been  in  the  front  when  our  country  was 
in  danger.  Its  record  during  the  War  of  the  Rebellion  stands 
foremost  in  the  history  of  the  nation.  It  gave  to  the  nation 
Abraham  Lincoln,  who,  during  the  dark  days  of  the  Rebellion, 
guided  the  Ship  of  State  through  many  a  storm  and  many  a 
danger  into  a  harbor  of  safety  and  gave  freedom  to  a  despised 
and  degraded  race.  It  gave  to  the  nation  Grant,  who  led  the 
army  from  victory  to  victory,  until  the  misguided  but  deter- 
mined foe  was  willing  to  sue  for  peace  and  accept  the  terms 
offered  by  its  conqueror.  It  gave  the  nation  a  Logan,  whose 
heroic  and  gallant  deeds  brought  terror  to  the  enemy.  It  gave 
the  nation  an  army  of  soldiers  who  took  an  honorable  and  heroic 
part  in  the  deadly  contiict.  It  gave  the  nation  Dick  Oglesby,  the 
intimate  friend  of  Lincoln,  who  happened  to  be  in  Washington 
on  the  memorable  night  of  Lincoln's  assassination.  The  moment 
the  fatal  shot  was  fired  he  was  summoned,  and  when  he  arrived 
at  the  entrance  of  the  house  to  which  Lincoln  had  been  taken, 
he  was  confronted  by  an  armed  guard  who  refused  him  admis- 
sion. There  was  no  time  for  argument ;  the  sturdy  Governor 
grasped  the  guard  by  his  collar  and  pushed  him  aside  like  a 


J.  N.  Reece,  Adjutant-General, 


toy,  with  the  words,  '*  I  am  the  Ciovernor  of  Illinois,  get  out  of 
my  way  I" 

Illinois  will  do  her  share  in  the  present  conflict.  When  the 
War  Department  called  for  troops,  the  message  was  received 
by  Governor  Tanner  on  April  26.  After  a  brief  consultation 
with  Adjutant-General  Reece,  the  button  was  touched  flashing 
the  order  over  the  wires  to  the  regimental  commanders  in 
different  parts  of  the  State,  and  in  less  than  thirty  six  hours 
10,000  men  were  at  the  State  Fair  Grounds  at  Springfield  ready 
to  do  their  duty.  General  Barkley,  the  senior  Brigadier  Gen- 
eral, was  placed  in  command  of  the  post,  which  he  named 
Camp  Tanner,  and  thanks  to  his  foresight,  energy  and  knowl- 
edge of  military  art.  the  troops  received  proper  shelter  and 
were  assigned  to  their  quarters  immediately  upon  their  arrival. 
Adjutant-General  Reece  demonstrated  by  every  act  that  he 
was  master  of  the  situation.  There  was  probably  never  a  time 
when  upon  such  short  notice  a  temporary  camp  for  so  large  a 
force  was  made  more  comfortable  and  efficient.  Both  of  these 
officers,  as  well  as  their  subordinates,  are  entitled  to  great 
credit  and  to  the  thanks  of  the  good  people  of  Illinois  for 
having  acted  so  promptly  and  wisely  to  efficiently  meet  such  an 
emergency.  The  newspaper  reporters  and  visitors  to  the  camp 
were  astonished  by  the  fact  that  no  complaints  were  made 
either  by  officers  or  men.  Considering  the  limitations  of  equip- 
ment, the  number  of  men  in  the  camp,  the  unprecedentedly 
disagreeable  weather  and  the  short  notice,  this  must  certainly 
appear  as  the  most  satisfactory  proof  of  the  intense  patriotism 
which  animated  every  man  and  made  him  ignore  his  physical 
requirements  in  the  thought  that  he  was  called  upon  to  dis- 
charge a  duty  to  his  country. 

A  few  days  after  the  arrival  of  the  seven  regiments  of  infan- 
try and  the  First  Regiment  of  Cavalry,  Captain  Veager  of  Bat- 
tery A,  First  Artillery,  appeared  in  camp  with  a  splendid  body 
of  well  drilled  men,  which  added  much  to  the  military  appear- 
ance of  the  camp.  The  representatives  of  the  United  States 
army,  Lieutenant  Colonel  Roberts,  Captain  Swift  and  Lieuten- 
ants Ballou,  Cole  and  Davis  were  on  the  field  early  and  ren- 
dered invaluable  service  in  the  organization  and  mustering  in 
of  the  troops.  It  was  indeed  pleasant  to  observe  the  harmony 
in  word  and  action  which  prevailed  between  these  officers  of  the 


regular  army  and  the  officers  and  men  of  the  National  Guard. 
This  war  will  do  much  in  cementing  together  more  closely  the 
professional  and  citizen  soldier.  In  less  than  four  weeks  all 
of  the  troops  were  examined,  mustered  into  the  United  States 
service  and  turned  over  to  the  Government. 


Lieuteiiaut-Colonel  Kobeils. 

The  Fifth  and  Third  Regiments  of  Infantry  were  the  first  to 
leave  Camp  Tanner  amid  the  cheers  of  their  comrades  left 
behind.  In  due  time  they  reached  their  appointed  station, 
Camp  George  H.  Thomas,  Chickamauga,  Ga.  The  Sixth 
Infantry  was  next  ordered  to  Camp  A  Iger,  Falls  Church,  Va., 


6 


near  Washington,  and  the  First  Infantry  a  few  days  later 
joined  their  comrades  of  the  Third  and  Fifth  Regiments  at 
Chickamauga.  The  Second  Infantry  was  then  ordered  to 
Tampa,  but  en  route  received  notice  to  report  at  Jacksonville, 
Fla.  The  Fourth  Infantry,  after  considerable  delay,  was 
ordered  to  Tampa,  the  Seventh  Infantry  to  Virginia,  and  the 
First  Cavalry  is  now  on  its  way  to  Camp  Thomas,  Chickamauga. 

GOVERNOR    TANNER. 

The  office  of  governor  of  a  State  is  always  important  and 
responsible,  but  especially  so  in  time  of  war.  The  citizens  of 
Illinois  have  reason  to  congratulate  themselves  that  during 
the  last  election  their  choice  fell  upon  the  right  man  at  the 
right  time.  Governor  Tanner  has  shown  that  he  is  made  of 
the  right  metal  for  an  effective  and  wise  war  governor.  His 
experience  during  the  late  war  as  a  private  has  been  of  great 
value  to  him  in  meeting  the  duties  of  the  hour.  He  knows 
what  it  is  to  serve  in  the  ranks,  and  has  therefore  taken  the 
deepest  interest  in  the  welfare  and  comfort  of  every  soldier  who 
has  come  to  the  camp.  He  is  a  staunch  friend  of  the  common 
people  (the  backbone  of  the  nation),  and  has  catered  but  little 
if  any,  to  the  whims  and  fancies  of  the  silk  stocking  element. 
He  is  now  more  popular  than  ever  with  the  National  Guard. 
He  takes  pride  in  his  army.  He  imbues  every  soldier  with  the 
idea  that  the  highest  position  is  within  his  reach  if  he  devotes 
himself  to  his  legitimate  duties.  He  has  strained  every  nerve 
in  bringing  his  troops  to  the  front,  and  has  had  the  satisfac- 
tion of  seeing  an  Illinois  regiment  the  first  to  be  mustered  into 
the  volunteer  service  of  the  United  States,  and  that  the  Stale 
he  represents  has  thus  taken  the  lead  as  regards  prompti- 
tude and  dispatch  in  answering  the  call  of  the  President  for 
volunteers. 

Our  Governor  is  intensely  patriotic  ;  he  has  shown  this  in 
every  act  in  the  organization  and  equipment  of  the  troops.  It 
is  not  generally  known  that  Governor  Tanner  is  a  great  orator  ; 
the  speech  which  he  made  at  a  banquet  he  gave  to  the  officers 
of  his  staff  and  of  the  regiments  in  camp,  was  a  revelation  to 
every  one  present.  He  seemed  to  be  inspired  ;  his  eyes  flashed  : 
every  nerve  and  muscle  responded  to  his  intense  emotion  ; 
every  word  and  thought  found  a  hearty  response  in  the  hearts 
of  his  profoundly  interested  audience.     I  doubt  very  much  if 


he  will  ever  be  able  to  duplicate  that  speech,  because  such  an 
occasion  comes  but  once  during  a  man's  life.  It  was  a  speech 
which  left  a  deep  and  permanent  impression,  a  speech  calcula- 
ted to  make  a  man  better  and  more  devoted  to  his  country  and 
his  country's  flag. 


John  R.  Tanner,  Governor  of  Illinois. 


8 


The  Governor  has  visited  the  camp  daily  and  always  has  a 
cheerful  word  and  a  pleasing  smile  for  everyone  he  meets,  pri- 
vates and  officers  alike.  John  R,  Tanner  will  go  down  in  his- 
tory as  a  famous  war  governor,  a  worthy  successor  to  Govern- 
ors Vates  and  Oglesby. 

MRS.    TANNEK. 

The  beautiful,  youthful  and  accomplished  wife  of  our  Gov- 
ernor came  to  the  Executive  Mansion  at  the  right  time.  She 
takes  great  interest  in  the  work  of  her  distinguished  husband. 


Mrs.  John  K.  Tauiier. 

She  is  a  great  favorite  with  the  people  of  Springfield.  She  is 
ready  in  conversation  and  quick  in  perception.  She  visits  the 
camp  frequently  and  takes  an  active  interest  in  the  care  of  the 
sick.  Her  cheerful  disposition  and  her  tender  care  of  her  hus- 
band have  done  much  to  lighten  the  heavy  burden  and  many 
perplexities,  which  have  been  resting  upon  the  shoulders  of 
our  overtaxed  Governor  since  he  assumed  the  duiies  of  his 
office,  and  more  particularly  since  the  declaration  of  war  with 
Spain. 


9 


THE   CAMP    GROUND. 

When  the  sudden  call  for  troops  came  it  was  an  important 
matter  to  select  a  camp  centrally  located  and  adapted  for  the 
season  of  the  year.  The  officers  of  the  State  Agricultural 
Society  came  to  the  rescue  of  the   military  authorities  and 


Brigadier-Geueral  James  H.  Barkley,  Senior  Coiumauder  of  the  Camp. 


10 


offered  gratuitously  the  State  Fair  Grounds  for  the  use  of  the 
troops  during  mobilization.  The  grounds  occupy  160  acres  of 
land,  north  of  the  city  limits,  and  are  easily  accessible  by  a  line 
of  electric  cars.  The  surface  of  the  ground  is  undulating  and 
divided  by  several  ravines  well  adapted  for  effective  surface 
drainage  with  a  little  expenditure  of  time  and  money.  The 
subsoil  is  of  clay,  which  in  combination  with  the  continued 
rains  made  the  streets  pools  of  mud  for  more  than  a  week,  a 
destroyer  of  foot  gear  and  a  rich  harvest  for  the  bootblack. 

The  permanent  buildings  were  well  adapted  for  temporary 
quarters  for  the  imperfectly  equipped  soldier.  For  two  weeks 
two  of  the  regiments  lived  in  tents.  The  camp  was  supplied 
with  filtered  water  from  the  Sangamon  River.  A  specimen  of 
the  water  was  sent  for  analysis  to  Dr.  A.  W.  Palmer,  professor 
of  chemistry  at  the  State  University,  who  pronounced  it  whole- 
some and  practically  pure. 

A  sufficient  number  of  sinks  were  dug  and  boarded  in  and 
the  dejecta  were  daily  covered  with  dry  earth.  Fresh  straw 
was  furnished  in  abundance.  The  rations  were  satisfactory 
both  in  quantity  and  quality, 

EXAMINATION  OF  SURGEONS  FOR  THE  UNITED  STATES  VOLUN- 
TEER SERVICE. 

Soon  after  the  troops  reached  Camp  Tanner  an  order  was 
sent  from  the  War  Department  to  Governor  Tanner,  making 
provision  for  the  formation  of  an  Examining  Board.  This 
board  was  to  consist  of  one  surgeon  from  the  United  States 
Army  and  two  National  Guard  surgeons.  The  Government 
detailed  Capt.  H.  P.  Birmingham,  U.  S.  A.,  stationed  at 
Chicago,  and  Governor  Tanner  appointed  Surgeon  General 
Senn  and  Brigade  Surgeon  C.  C.  Carter  of  Rock  Island,  as 
members  of  the  board.  The  duties  of  this  board  were  to  con- 
sist in  the  examination  both  as  to  physical  condition  and  pro- 
fessional attainments  of  applicants  for  commissions  in  the 
Medical  Department  of  the  United  States  volunteers  and  the 
National  Guard  volunteer  forces.  The  board  was  organized  at 
once  and  proceeded  to  examine  applicants  for  the  Medical 
Department.  The  following  blank  was  drawn  up,  typewritten, 
and  presented  to  each  applicant  to  fill  out : 

Applicants  for  the  volunteer  service  are  respectfully  requested 
to  fill  out  carefully  the  following  blanks : 


11 


1.  Name .   2.  Age .   3.  Height ■.    i.  Weight . 

5.  Family  history .     6.  Physical  defects,  if  any,  either  of 

congenital  or  acquired  sources .     7.  Residence  and  P.  O. 

address .     8,  Command,   if  any .     9.  Place  and  date 

of  graduation ,      10.  Professional  or  scientific  study  and 

investigation,  other  than  military .     11.  Foreign  languages 

studied ;  a,  able  to  speak :  b,  jiIjIo  to  translate 


Surgeons  of  the  National  Guard  and  Illinois  Volunteers. 

12.  Subjects  or  titles  of  books  written  or   published,    essays 
prepared,  lectures  delivered  or  papers  read,  when  and  where 

;  a,  No. ;  b, ;  c, .     Remarks . 

The  physical  examination  was  made  in  a  very  thorough  man- 
ner, the  man  being  stripped,  and  demonstrated  that  the  candi- 
dates for  commissions  in  the  Medical  Department  compared 
favorably  with  the  line  and  field  officers.  Out  of  the  whole 
number  only  three  were  rejected. 


12 


It  was  the  intention  of  the  Board,  in  view  of  the  fact  that 
most  of  the  candidates  had  done  good  service  in  the  National 
Guard  for  a  longer  or  shorter  period,  to  make  the  examination 
as  broad  and  practical  as  possible.  The  following  are  some  of 
the  subjects  on  which  the  examination  was  conducted  : 

Anatomy  and  Surgery. — 1.  Give  the  origin  and  distribution 
of  the  pneumogastric  nerve.  2.  Mention  the  bones  of  the  car- 
pus and  give  their  relative  locations  by  illustration.  3.  Describe 
the  innominate  artery  and  give  its  relations  to  surrounding 
structures.  4.  Enumerate  the  different  hemostatic  measures 
and  describe  their  technic  and  indications.  5.  Detail  the  treat- 
ment of  recent  compound  fracture  of  the  leg.  6.  Describe  the 
different  amputations  through  and  below  the  ankle  joint  and 
mention  the  names  of  the  surgeons  who  devised  them. 

Hygiene. — 1.  Give  your  ideas  on  the  selection  and  sanitation 
of  camps.  2.  The  prophylaxis  and  treatment  of  sunstroke. 
3.  How  would  you  determine,  in  the  field,  in  a  general  way, 
the  salubrity  of  the  water-supply,  and  what  measures  would 
you  take  for  preventing  its  pollution? 

Military  surgery. — 1.  Give  method  of  treating  (temporary) 
gunshot  fracture  of  the  thigh,  on  the  field,  and  when  and  how 
would  you  remove  the  patient?  2.  What  is  the  effect  produced 
by  modern  small  jacketed  bullet,  compared  with  the  old  large 
caliber  missile?  3.  Give  method  of  procedure  in  rendering 
first  aid  to,  and  removal  of,  wounded  from  fighting  line  to  field 
hospital. 

Practice  of  medicine. — 1,  Describe  pneumonia  :  Definition, 
etiology,  morbid  anatomy,  symptoms,  complications,  prognosis, 
termination,  diagnosis,  treatment,  2,  Describe  cerebrospinal 
meningitis  :  Cause,  pathology,  symptoms,  diagnosis,  prognosis, 
treatment.  3.  Describe  diseases  most  liable  to  occur  in  trop- 
ical countries,  with  short  description  of  causes,  symptoms, 
pathology,  prophylaxis,  diagnosis  and  treatment. 

Materia  medica.—l.  What  are  the  more  common  forms  of 
mercury  used  in  medicine?  Write  prescriptions  for  four.  2. 
Mention  the  comparative  advantages  of  ether  and  chloroform 
as  anesthetics.  3.  Indications  for  the  use  of  emetics,  cathar- 
tics and  alcohol. 

The  minimum  standard  was  fixed  at  70.  It  was  a  source  of 
great  gratification  to  the  Board  that,  notwithstanding  the  fact 


13 


that  many  of  the  applicants  had  been  busy  practitioners  for 
years,  the  papers  they  turned  in  were  of  a  high  character.  The 
result  of  the  examination  shows  that  in  these  applicants  the 
State  had  desirable  material  for  service  in  the  volunteer  regi- 
ments. 

The  fact  that  the  revised  code  of  the  Illinois  National  Guard 
made  provision  for  five  surgeons  to  each  regiment  and  the 
regulation  for  the  United  States  Volunteer  Service  called  for 


j 

mk 

..  |rj^y  -^ 

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1^ 

Group  of  Hospital  Stewards  Illinois  Volunteers. 

only  three,  made  it  necessary  for  the  junior  assistant  surgeons 
of  some  of  the  regiments  to  return  unwillingly  to  their  respec- 
tive homes. 

As  soon  as  the  results  of  the  examination  were  announced, 
the  assignments  were  made.  The  following  is  a  list  of  the 
medical  officers  of  the  volunteer  forces  of  Illinois  : 

First  Infantry.  Surgeon,  W.  G.  Willard ;  Assistant  Sur- 
geons, T.  E.  Roberts  and  C.  B.  Walls. 


14 

Second  Infantry.  Surgeon,  G.  F.  Lydston  ;  Assistant  Sur- 
geons, J.  (i.  Byrne  and  G.  P.  Marquis. 

Third  Infantry.  Surgeon,  J.  B.  Shaw  ;  Assistant  Surgeons, 
A.  F.  Lemke  and  C.  E.  Starrett. 

Fourth  Infantry.  Surgeon,  T.  C.  McCord  ;  Assistant  Sur- 
geons, C.  M.  Galbraith  and  G.  E.  Hilgard. 

Fifth  Infantry.  Surgeon,  M.  R.  Keeley  ;  Assistant  Surgeons, 
E.  A.  Ames  and  J.  L.  Bevans. 

Sixth  Infantry.  Surgeon,  F.  Anthony  ;  Assistant  Surgeons, 
C.  A.  Robbins  and  L.  S.  Cole. 

Seventh  Infantry,  Surgeon,  T.  J.  Sullivan  :  Assistant  Sur- 
geons, G.  W.  Mahoney  and  F.  P.  St.  Clair. 

First  Cavalry.  Surgeon,  W.  Cuthbertson;  Assistant  Sur- 
geons, T.  J.  Robeson  and  J.  Rowe. 

Battery  A,  First  Ariillery.     Hospital  Steward,  Dr.  Jackson. 

PHYSICAL  EXAMINATION  OF  FIELD  AND  LINE  OFFICERS 
AND  ENLISTED  MEN. 

The  examinations  were  conducted  at  the  Senate  Chamber  of 
the  State  House  from  9  a.m.  to  6  p.m.  daily,  with  an  interval  of 
an  hour  for  lunch.  The  Board  of  Examiners  was  assisted  by 
the  regimental  surgeon  of  each  regiment  and  his  assistants. 
The  officers  were  examined  separately  in  the  Lieutenant  Gov- 
ernor's room.  One  of  the  assistant  surgeons  took  the  chest 
expansion,  another  examined  the  eyes  and  ears  and  a  third  the 
head,  mouth,  pharynx  and  neck.  The  Surgeon-General  exam- 
ined the  lower  extremities  and  abdomen,  and  Captain  Birming- 
ham the  chest  and  the  general  aptitude  for  active  service. 
Colonel  Carter  acted  as  clerk  in  conjunction  with  a  number  of 
the  field  and  line  officers. 

The  following  blanks  for  physical  examination  were  drawn 
up,  and  10,000  copies  were  jjrinted  and  distributed  to  the  vari- 
ous regiments : 

physical    EXAMINATION. 

Name .    Rank .  Co. .   Regiment .  Age . 

Residence  .      Chest  Expansion  .       Inspiration  . 

Expiration  ,     Are  you  subject  to  coughs  or  colds?  . 

Have  you  ever  had  any  serious  illness? .     Are  you  subject 

to  sore  throat? .     Discharge  of  the  ear? .     Rheuma- 
tism?   .     Stiffening  of  the   joints?  .     Hemorrhoids   or 

piles? .     Fistula? .     Diarrhea  or  dysentery? .    Do 

you  believe  you  are  sound  and  well  now? . 


15 


Soon  after  the  arrival  of  the  Surgeon-General  an  order  was 
issued  instructing  the  regimental  medical  officers  to  make  a 
preliminary  physical  examination  of  the  recruits,  which  resul- 
ted in  the  return  to  their  homes  of  several  hundred  men  phys- 


'/^VJTtH^D  [^'  " 


ically  unfit  for  duty  and  which  materially  assisted  the  work  of 
final  examination.  The  most  unenviable  part  of  the  examina- 
tion fell  upon  the  shoulders  of  the  Surgeon-General,  who  for 
the  purpose  of  quickening  and  lightening  his  duties  devised 


16 


the  following  commands :  Heels  together  I  Turn  around  I 
Turn  back  I  Cough  I  Cough  harder  I  which  ccmmands  after- 
ward became  a  favorite  and  familiar  chorus  among  the  men 
who  passed  the  final  ordeal  to  the  satisfaction  of  the  Board. 
On  an  average,  it  was  found  possible  by  following  the  thorough 
system  adopted,  to  examine  from  800  to  950  recruits  a  day.  In 
all,  9899  men  were  examined. 

The  most  common  causes  for  rejection  were  hernia,  varicose 
veins  of  the  lower  extremities,  poor  physi«iue,  heart  disease, 
imperfect  chest  expansion,  loss  of  teeth  and  flat  foot.  The 
presence  of  varicocele  of  different  degrees  in  men  otherwise 
apparenly  in  good  health  was  marked.  It  was  found  that 
nearly  25  per  cent,  of  all  those  examined  presented  a  condition 
of  varicocele  of  some  degree.  Only  two  recruits  were  rejected 
for  this  cause,  as  in  their  cases  the  varicocele  appeared  to  be 
an  acknowledged  source  of  pain.  In  all  the  rest  the  statement 
was  plainly  made  either  that  the  applicant  had  no  knowledge 
of  the  condition,  or  that  it  gave  rise  to  no  inconvenience.  In 
probably  one-half  of  all  the  cases  the  subjects  were  ignorant 
of  the  existence  of  this  condition.  The  same  remark  may 
apply  to  flat  foot  as  a  cause  of  rejection,  inasmuch  as  the 
deformity  appeared  to  be  extremely  common,  but  only  in  a 
few  isolated  cases  was  it  a  cause  of  pain  and  consequently  of 
disability  for  the  volunteer  service.  The  rejections  for  good 
and  substantial  causes  were  less  than  10  per  cent.  This  was 
influenced  somewhat  by  the  thoroughness  with  which  the  pre- 
liminary examinations  had  been  conducted.  The  proportion  of 
rejections  was,  on  the  whole,  larger  in  the  country  regiments 
than  in  those  made  up  of  Chicago  men.  A  great  many  men 
who  passed  the  physical  examination  returned  unwillingly  to 
their  homes  by  reason  of  the  regulation  reducing  the  number 
of  men  to  a  company  from  109  to  Si. 

The  intensity  of  the  patriotic  feeling  which  pervaded  the 
men  in  camp  is  best  shown  by  the  illustrations  which  accom- 
pany this  communication.  The  word  "rejected"  in  many 
instances  seemed  to  make  a  more  profound  impression  than 
would  a  death  sentence.  The  disappointment  would  be  such 
that  the  soldier  was  often  speechless,  pale,  staggering,  and  in 
not  a  few  instances  hot  tears  would  roll  down  the  bronzed 
cheeks  as  the  best  evidence  of  the  deep  regret  of  the  recruit 


19 


20 


of  both  field  and  line  officers,  who  did  everything  in  their  power 
to  encourage  them  in  their  work. 

LECTURES  ON    FIRST  AID. 

On  May  10,  the  Surgeon-General  issued  the  following  order  : 
"Regimental  surgeons  are  requested  to  give  officers  and  men  in 
their  commands  instruction  in  first  aid  or  self  help,  as  the  case 
may  be,  in  the  following  subjects  :  Diet  and  drink  in  health 
and  disease.  Care  of  the  person,  bathing,  clothing,  feet,  etc. 
What  to  do  in  sunstroke.  Temporary  treatment  of  fractures. 
Temporary  arrest  of  hemorrhage.  Transport  of  injured  men. 
Application  of  first  aid  dressings.  The  illustrated  triangular 
bandage  will  be  furnished,  to  be  displayed  in  a  conspicuous 
place  in  company  quarters  so  that  every  man  may  understand 
its  application." 

These  lectures  were  well  attended  and  proved  of  signal  value 
in  preparing  the  line  officers  and  men  in  the  use  of  the  first  aid 
package,  and  in  the  prevention  and  treatment  of  hemorrhage, 
as  well  as  enlightening  them  on  the  subjects  of  hygiene  and 
sanitation. 

VACCINATION. 

On  May  12,  the  Surgeon- General  issued  the  following  order  : 

"To  all  surgeons  and  assistant  surgeons  : 

"Vaccination  by  regiments  will  take  place  as  soon  as  they  are 
mustered.     You  are  directed  to  operate  according  to  the  fol 
lowing  rules,  assisted  by  your  hospital  stewards  : 

"1.  The  left  arm  is  to  be  bared.  A  space  four  inches  square 
at  the  outer  border  of  the  deltoid  midway  between  its  origin 
and  insertion  is  to  be  thoroughly  scrubbed  with  warm  water 
and  potash  soap,  then  cleansed  with  alcohol  and  finally  washed 
with  pure  water  and  dried  with  a  pledget  of  absorbent  cotton. 

"2.  The  arm  is  to  be  lightly  scarified  where  cleansed  for  a 
space  of  one-half  inch  square.  Both  ends  of  the  vaccin  tube 
are  to  be  broken  off,  and  the  virus  blown  on  the  wound  with 
the  rubber  bulb  furnished,  and  thoroughly  rubbed  in  with  the 
point  of  the  lancet.  The  lancet  is  to  be  cleansed  with  alcohol 
after  each  scarification. 

"3.  The  arm  is  to  be  left  exposed  until  thoroughly  dry.  A 
pledget  of  sterile  cotton  two  inches  square,  is  to  be  placed  over 
the  wound  and  held  in  place  by  an  adhesive  strap  one-half  inch 
wide  and  four  inches  long." 


21 


There  is  reason  to  believe  that  the  above  specific  directions 
did  much  in  the  prevention  of  septic  complications. 

CAMP    DISEASES. 

The  season  of  the  year  at  which  the  troops  were  called  out, 
the  crowded  condition  of  the  camp,  the  imperfect  equipment  of 
the  men,  the  continuous  rain  for  over  a  week,  and  the  change- 
able temperature  were  influences  well  calculated  to  test  the 
strength  and  power  of  resistance  to  disease  of  the  men  who 
sought  the  service  of  the  Government. 

The  appearance  of  cerebrospinal  meningitis  on  the  first  day 
the  troops  were  in  camp  in  the  case  of  a  man  of  K  troop.  First 
Cavalry,  excited  much  interest,  and  as  this  was  followed  in 
rapid  succession  by  three  additional  cases  in  other  commands, 
led  to  a  thorough  investigation  as  to  the  origin  and  spread  of 
this  disease.  This  investigation  was  conducted  by  Lieutenant 
Colonel  Kreider  pursuant  to  an  order  from  the  Surgeon  ( Gen- 
eral.    Colonel  Kreider  presented  the  following  report : 

Camp  Tanner,  Springfield,  May  23,  1898. 
Colonel  N.  Senn, 

Surgeon-General,  I.  N.  G.,   Camp  Tanner,  111. 

Sir: — Pursuant  to  your  order  to  investigate  the  origin  and 
spread  of  the  cases  of  cerebro  spinal  meningitis  which  have 
occurred  at  this  camp,  I  have  the  honor  to  report  that  up  to 
this  time  three  cases  have  appeared,  all  of  which  have  resulted 
fatally. 

1.  Ernest  Royal  Parish,  of  Troop  K,  First  Cavalry.  On  my 
request,  Major  William  Cuthbertson  assigned  to  the  First  Cav- 
alry made  the  following  report :  "He  was  ailing  for  some  days 
prior  to  enlistment.  While  waiting  at  Tattersall's  at  Chicago 
I  have  ascertained  that  he  was  compelled  to  lie  down,  but  was 
up  and  able  to  pass  inspection.  He  was  taken  violently  ill  on 
the  train  on  the  way  down,  with  chills  and  vomiting.  On 
reaching  Springfield  in  the  morning  he  was  unable  to  walk  and 
was  removed  to  the  Post  Hospital  on  a  stretcher.  As  soon  as 
possible  he  was  transferred  from  there  to  St.  John's  Hospital, 
where  he  now  lies.  I  have  just  learned  that  another  case  of 
this  disease  exists  at  Western  Springs,  the  patient's  home." 
Parish  died  May  1.  As  stated  in  Surgeon  Cuthbertson' s 
report,  he  had  not  placed  a  foot  on  the  camp  ground,  and  his 
stay  there  did  not  exceed  half  an  hour. 


22 


2.  Edward  B.  Beebe,  of  the  Third  Infantry,  residing  at 
Elgin,  was  sent  to  the  Hospital  May  13  by  the  Surgeon  of  the 
Regiment  on  the  eve  of  its  departure,  and  was  first  seen  by  me 
on  the  following  morning.  In  the  afternoon  I  found  him  deli 
rious,  so  that  he  required  restraint  and  constant  watching, 
which  was  given  by  a  hospital  steward  of  the  Second  Infantry. 
He  died  May  15. 

3.  Robert  Leland,  of  Third  Infantry,  residing  at  Ottawa,  was 
first  seen  by  me  at  the  camp  at  6  p.m..  May  14,  and,  as  all  am- 
bulances were  in  use,  was  conveyed  in  my  buggy  to  the  Hospital. 
Assistant  Surgeon  Lemke  writes  of  the  onset  of  the  disease  as 
follows  :  '  'I  saw  him  at  noon,  when  he  was  complaining  of  intense 
headache.  He  became  delirious  the  same  night,  although  he  was 
rational  when  aroused."  The  disease  ran  a  very  rapid  course 
and  death  occurred  May  17  at  11  p.m.  From  his  family  phy- 
sician I  have  learned  that  a  sister  aged  20  and  a  brother  aged 
15  had  died  of  tuberculosis.  As  ordered,  I  had  intended  hold 
ing  a  postmortem  on  this  case,  but  the  body  was  removed 
from  the  Hospital  at  2  a.m.  by  his  father. 

The  disease  in  the  first  case  may  be  traced  to  other  cases  in 
his  home  town.  He  was  not  associated  in  any  way  with  the 
men  of  the  Third  Regiment,  and  it  seems  hardly  probable  that 
the  disease  could  have  been  transmitted  from  him  to  the  others. 
It  seems  probable  that  the  disease  in  the  Third  Infantry  was 
caused  by  the  crowded  and  poorly  ventilated  quarters  which 
this  regiment  occupied,  or  by  the  damp  straw  on  which  they 
slept.  Each  of  these  conditions  was  caused  by  the  weather  pre 
vailing  during  the  stay  of  this  regiment  at  the  camp.  Because 
of  the  rains  the  men  did  not  leave  the  building  during  the  day, 
and  thus  the  rooms  became  foul.  1  called  the  attention  of  the 
Surgeon  of  the  Regiment  to  this  foul  odor  early  in  the  tour; 
because  of  the  rain  also,  the  straw  was  brought  in  damp  and 
may  have  figured  in  causing  the  trouble. 
Respectfully, 
[Signed]  Geor(;e  X.  Kreider,  Post-Surgeon. 

Among  theother  camp  diseases  must  be  mentioned  pneumo 
nia,  measles  and  mumps.  The  pneumonia  contracted  in  the 
camp  proved  to  be  of  an  unusually  malignant  type.  Of  the 
thirty-two  cases  only  two  died,  a  mortality  of  about  6  per  cent. 

Upon  the  outbreak  of  measles   an   isolated   part  of  camp 


23 

ground  was  selected  for  an  isolation  hospital,  and  placed  under 
guard  with  a  yellow  tiag  in  front  of  the  hospital  tent.  Three 
cases  of  measles  and  three  or  four  cases  of  mumps  occurred. 
The  patients  were  placed  in  separate  hospital  tents,  and  as  soon 
as  they  recovered  from  the  illness  were  subjected  to  a  thorough 
disinfection  and  their  clothing  disinfected  before  they  were 
allowed  to  return  to  duty.  This  isolation  of  patients  suffering 
from  infectious  diseases  proved  effectual  in  the  prevention  of 
a  further  spread  of  the  diseases. 

The  ranks  of  the  medical  department  were  broken  at  an  early 
date  by  the  untimely  death  from  pneumonia  of  Assistant-Sur- 
geon Cole  of  the  Sixth  Infantry,  who  was  taken  ill  while 
en  route  with  his  regiment  to  Washington,  and  died  at  Port 
Wayne,  Ind.  Upon  reeeipt  of  the  news  of  his  death  the  medi- 
cal officers  drew  up  the  following  resolutions : 

Whereas,  By  the  untimely  death  of  our  comrade.  Lieuten- 
ant L.  S.  Cole,  Assistant  Surgeon,  Sixth  Illinois  Infantry,  U. 
U.  A.,  a  career  of  brilliant  promise  has  been  cut  short,  be  it 

Resolved,  That  in  the  death  of  Lieutenant  Cole  the  State  of 
Illinois  has  lost  a  valuable  medical  officer  and  the  medical 
profession  an  efficient  and  able  member. 

Resolved,  That  we,  the  members  of  the  Medical  Department, 
of  the  Illinois  National  Guard  and  United  States  Volunteers  at 
Camp  Tanner,  extend  to  his  bereaved  family  and  friends  our 
condolence  and  sincere  sympathy. 

Resolved,  That  copies  of  these  resolutions  be  sent  to  his 
mother,  and  to  his  regiment. 
(Signed) 
T.  J.  Sullivan,  Major  and  Surgeon  Seventh  Infantry. 
T.  C.  McCoRD,  Major  and  Surgeon  P^ourth  Infantry. 
Wm.  CuTHBERTSON,  Major  and  Surgeon  First  Cavalry. 
S.  C.  Stanton,  First  Lieut,  and  Ass' t. -Surgeon,  I.N.G. 

Committee. 

With  this  communication  my  official  connection  with  the 
National  Guard  of  Illinois  is  temporarily  severed,  as  I  have 
been  mustered  in  as  Lieutenant- Colonel  and  Chief  Surgeon, 
Sixth  Army  Corps,  U.S.V.,  to  be  assigned  to  the  command  of 
Major  General  Wilson,  Camp  George  H.  Thomas,  Chicka- 
mauga,  Ga. 


AN  OLD   BATTLE   GROUND. 

Chickamauga,  June  3,  1898. 
Chickamauga  I  What  a  terrible  name  to  the  reunited  nation  I 
Here  was  enacted  one  of  the  bloodiest  dramas  in  American  his- 
tory. It  is  here  where  one  of  the  most  desperate  battles  of  the 
War  of  the  Rebellion  was  fought.  Almost  every  foot  of  soil  of 
this  great  National  Park  was  stained  with  the  blood  of  heroes 
on  both  sides.  What  a  grand  spectacle  this  beautiful  park 
must  have  presented  when  it  was  the  scene  of  one  of  the  great- 
est battles  known  to  history  I  Two  great  armies  composed  of 
the  same  flesh  and  blood,  face  to  face,  engaged  in  a  deadly  con- 
flict. Upon  the  issue  depended  much  on  both  sides,  hence  the 
heroism  displayed  and  the  terrible  sacrifice  of  life.  It  seems  to 
me  I  can  hear  now  the  beat  of  the  drum,  the  shrill  voice  of  the 
fife,  the  thundering  roar  of  cannon,  the  rattle  of  musketry, 
the  shouts  of  command,  the  groans  of  the  wounded  and  the 
labored  breathing  of  the  dying.  The  bullet-riddled  trees,  the 
innumerable  cannon  occupying  the  same  position  as  when  they 
vomited  forth  fire,  death  and  destruction,  the  many  beautiful 
monuments  and  tablets  commemorating  the  position  of  troops 
during  action,  and  the  places  where  distinguished  leaders  fell, 
are  the  silent  witnesses  of  those  awful  days  when  our  Nation 
was  threatened  by  disruption  and  even  death.  It  was  no  fault 
of  our  valiant  enemy  that  the  star  spangled  banner  triumphed. 
The  victory  was  dearly  bought.  Thousands  of  brave  soldiers 
are  resting  in  yonder  cemetery.  Many  wounds  inflicted  still 
remain.  Many  an  aged  mother  and  father  have  had  their  life 
saddened  by  an  irreparable  loss  sustained  in  that  battle.  Many 
an  empty  chair  has  remained  in  numerous  lonely  households. 
It  will  take  more  than  another  generation  to  wipe  out  the 
immediate  consequences  of  the  horrors  of  that  battle.  Let  the 
present  and'all  coming  generations  remember  with  veneration 
and  true  gratitude  the  heroic  deeds  enacted  here.  Years  have 
gone  by  and  this  great  park  has  become  again  the  camping 
ground  of  a  large  army.  Within  a  few  weeks  nearly  fifty 
thousand  men  have  pitched  their  tents  and  are  making  active 


25 


preparations  for  war.  The  hills,  fields,  woods  and  ravines  are 
swarming  with  soldiers.  Mounted  officers  are  galloping  in  all 
directions  in  clouds  of  dust.     Brigades,  regiments,  companies 


and  squads  are  hard  at  drill  under  the  burning  sun.  Sentries 
are  stationed  everywhere  to  preserve  order,  protect  property 
and  learn  the  art  of  watch  dogs  to  protect  the  troops  during 
the  active  campaign  along  the  coast  and  in  distant  islands,  the 


26 


the  prospective  fields  of  warfare.  Almost  every  day  new  regi- 
ments arrive  from  every  part  of  the  country,  often  without 
arms  and  uniforms,  but  eager  and  ready  to  be  instructed  in 
the  art  of  war.  Our  patriotic  citizen  soldiers  in  civilian  drees 
env>  their  more  fortunate  comrades  in  showy  blue,  and  impa- 
tiently await  their  turn  to  don  the  soldier's  garb.  It  is  refresh- 
ing and  interesting  to  observe  what  patriotism  will  do  in 
antagonizing  the  imperfections  and  hardships  of  camp  life. 
Do  you  imagine  you  could  hire  many  of  these  soldiers  to  do 
ordinary  work  under  similar  conditions  at  §5  per  day?  No ! 
Give  them  a  uniform,  a  gun,  and  an  opportunity  to  fight  for 
the  honor  of  their  country  and  the  glorious  stars  and  stripes, 
and  they  rush  to  the  front  without  a  word  of  complaint, 
unconscious  of  the  privations  and  hardships  incident  to  the 
life  of  the  soldier. 

SANITARY    CONDITIONS, 

Chickamauga  Park  is  admirably  adapted  for  a  large  camp. 
It  embraces  several  square  miles.  The  forest  trees  furnish 
protection  against  the  burning  rays  of  the  semitropical  sun  and 
the  many  open  places  and  fields  are  utilized  as  drill  grounds. 
Humus  is  scanty  and  the  subsoil  is  of  clay.  The  surface  is 
somewhat  undulating  and  is  cut  up  here  and  there  by  ravines, 
which  add  much  to  the  beauty  of  the  scenery.  An  ample  sup- 
ply of  pure  water  is  obtained  from  numerous  wells,  from  15  to 
65  feet  in  depth,  recently  supplemented  by  a  pumping  station 
which  derives  the  water  from  the  river,  a  short  distance  below 
Crawfish  Springs,  and  distributes  the  water  to  different  parts 
of  the  park  through  iron  pipes.  The  vastness  of  the  grounds 
are  realized  by  the  visitor  as  soon  as  he  reaches  George  H. 
Thomas  camp,  which  at  the  present  time  is  occupied  by  nearly 
50,()00  men,  and  yet  seldom  more  than  one  regiment  can  be 
seen  at  one  and  the  same  time.  In  the  past,  Chickamauga  has 
had  an  unenviable  reputation  as  a  health  resort.  The  Indian 
name  Chickamauga  signifies  literally  "River  of  death."  Along 
the  banks  of  the  Chickamauga  river,  which  flows  through  the 
park,  malaria  was  very  prevalent  years  ago,  which  probably 
had  something  to  do  in  inducing  the  Indians  to  designate  this 
river  by  such  a  terrifying  name.  At  the  present  time  malaria 
has  nearly  disappeared  from  this  part  of  the  country,  except  a 
very  localized  district  north  of  Crawfish  Springs.     The  malaria 


27 


contracted  in  this  circumscribed  locality  has  been  of  a  mild 
form  and  is  probably  due  to  the  draining  of  a  little  pond  on  the 
south  side  of  Park  Hotel. 

An  adequate  number  of  sinks  from  four  to  eight  feet  in 
depth  have  been  dug  a  safe  distance  from  tents  and  field  hos- 
pitals, all  of  which  are  boarded  in.  Three  times  a  day  the 
deposits  in  the  sinks  are  covered  with  dry  earth  and  ashes 
from  the  stoves  and  camp  fires.  One  of  the  difficulties  so 
constantly  prevailing  in  camps  has  been  the  introduction  of 
harmful  articles  of  diet  by  interested  friends  and  enterprising 
merchants.  The  regulations  governing  this  evil  are  becom- 
ing more  and  more  stringent  and  are  more  eflfectively  carried 
out,  so  that  the  danger  from  this  source  is  diminishing  pro- 
gressively, 

PREVAILING    CAMP    DISEASES. 

The  most  common  disease  affecting  the  troops  at  this  time  is 
diarrhea.  The  continuous  heat,  the  change  and  often  impru- 
dence in  diet  and  sleeping  on  the  ground  are  the  most  impor- 
tant etiologic  elements.  The  last  mentioned  cause  becomes 
apparent  from  the  fact  that  the  privates  are  much  more  fre- 
quently affected  proportionately  than  the  commissioned  officers, 
most  of  whom  enjoy  the  luxury  of  a  cot.  A  number  of  deaths 
have  occurred  from  cerebro  spinal  meningitis,  more  especially 
among  the  Illinois  troops.  In  my  first  communication  I  traced 
the  disease  to  Camp  Tanner,  where  it  originated  from  a  case 
brought  there  by  the  first  regiment  of  cavalry.  A  few  days 
ago  Capt.  Lemke,  3rd  Regiment  Illinois  Volunteers,  made  a 
postmortem  examination  at  the  Ist  Division  Hospital,  1st  Army 
Corps,  which  demonstrated  the  pathological  appearances  of 
the  disease  to  perfection.  There  was  a  difference  of  opinion  in 
reference  to  the  location  and  nature  of  the  disease,  as  during 
the  early  history  of  the  case  the  symptoms  referable  to  the 
cerebro-spinal  centers  were  conspicuous,  while  later  a  compli- 
cating pneumonia  masked  the  manifestations  of  the  original 
disease.  The  examination  showed  croupous  pneumonia  involv- 
ing one  lobe  of  the  lung,  of  recent  origin,  while  the  meninges 
of  the  brain  and  spinal  cord  presented  all  the  evidences  of  an 
acute  inflammation.  The  lining  membranes  of  all  the  ventricles 
were  involved.  The  pathological  changes  were  most  marked 
at  the  base  of  the  brain  and  more  especially  the  pons  Varolii 


28 


and  medulla  oblongata.     In  these  localities  the  meninges  were 
found  infiltrated  and  covered  with  a  plastic  exudate. 

The  remaining  portions  of  the  membranes  enveloping  the 
brain  and  cord  were  extremely  vascular  and  in  some  places 
presented  an  opalescent  appearance.  A  considerable  quantity 
of  turbid  serum  was  found  in  the  ventricles  and  subarachnoid 
space.  It  was  evident  from  the  postmortem  appearances  that 
the  primary  disease  involved  the  nervous  centers  and  that  the 
lobar  pneumonia  set  in  later  as  a  complication  and  contributed 
toward  an  early  fatal  termination.  Two  cases  of  cerebro  spinal 
meningitis,  presenting  grave  symptoms  observed  in  Camp 
Tanner,  improved  promptly  after  lumbar  puncture  and  I  have 
been  subsequently  informed  that  both  of  these  cases  ultimately 
recovered.  The  first  tapping  was  made  by  Lieut.  Rowe  of  the 
1st  Illinois  Cavalry.  All  cases  of  cerebro  spinal  meningitis 
that  have  been  sent  to  the  Division  Hospital  have  been  placed 
in  isolation  tents  for  the  purpose  of  preventing  further  spread 
of  the  disease.  Measles  has  broken  out  in  the  camp  and  all 
patients  suffering  from  this  disease,  about  twenty  in  number, 
at  the  present  time  are  under  guard  in  isolation  tents.  The 
disease  is  mild  in  type,  the  patients  as  a  rule  being  confined  to 
bed  not  longer  than  four  or  five  days.  Pneumonia  has  been 
prevalent,  especially  among  the  regiments  from  the  northern 
States.  Delirium  is  usually  absent  although  the  disease  other- 
wise has  assumed  a  grave  type.  In  several  fatal  cases  the 
postmortem  changes  indicated  that  death  resulted  from  sec- 
ondary streptococcus  infection.  At  the  present  time  there  are 
only  three  or  four  cases  of  typhoid  fever  in  camp  and  in  most 
of  them  it  is  more  than  probable  that  the  disease  was  con- 
tracted before  the  patients  reached  the  camp.  Considering 
the  inadequate  clothing  of  many  of  the  volunteers,  the  heavy 
dew  and  the  chilliness  experienced  some  nights,  it  is  remarka- 
ble that  so  few  suffer  from  rheumatism  and  bronchitis.  Sun- 
stroke and  heat  exhaustion  have  so  far  not  visited  the  camp, 
although  heavy  marching  and  active  drilling  often  take  place 
with  the  sun  high  up  in  the  horizon.  On  the  whole  the  health 
of  the  troops  is  excellent. 

A    TIMELY    BENEFACTRESS. 

As  soon  as  I  arrived  at  Camp  George  H.  Thomas  I  called  on 
Lieut.  Col.  Harteuff,  U.  S.  A.,  who  received  me  very  kindly 


29 


and  spent  nearly  half  a  day  in  showing  me  the  location  of  regi- 
ments and  field  hospitals.  His  experience  since  he  took  charge 
of  the  medical  affairs  of  the  camp  had  taught  him  that  the 
hospital  facilities  even  with  the  limited  number  of  sick  at  the 
present  time  were  entirely  inadequate.     Near  the  park  and  on 


:30 


the  south  Bide  of  it,  adjacent  to  the  famous  Crawford  Springs  is 
a  large  well  built  hotel  containing  seventy  rooms,  which  had 
recently  been  evacuated  and  on  which  he  had  an  option  for  a 
few  days,  purchase  price  810,000.  The  building  alone  cost 
$65,000  and  as  the  purchase  price  included  the  entire  furni- 
ture, water  privilege  and  four  acres  of  land,  and  the  building 
was  in  a  condition  that  it  could  be  occupied  at  once  without 
much  repair  he  had  strongly  recommended  its  purchase  for 
hospital  purposes  to  the  Surgeon-General.  There  was  no  ques- 
tion as  to  the  desirability  of  acquiring  the  property  to  better 
and  increase  the  hospital  facilities ;  neither  could  there  be  any 
doubt  of  the  government's  willingness  to  buy  it  to  meet  the 
existing  emergency,  but  past  experience  satisfied  all  concerned 
that  it  would  take  weeks,  and  perhaps  months,  before  the 
building  could  be  made  available  by  relying  on  the  routine  way 
in  acquiring  the  property.  Recognizing  the  necessity  for  imme- 
diate action  in  the  premises  and  the  fact  that  the  option  was 
open  only  for  a  few  days,  at  the  expiration  of  which  the  ovi^ners 
intended  to  reopen  the  hotel,  I  asked  permission  of  Col.  Hart- 
suff  to  allow  me  to  make  an  attempt  to  secure  the  building  by 
donation  and  later  present  it  to  the  Government,  This 
request  was  willingly  granted.  I  telegraphed  to  Mrs.  L.  Z. 
Leiter,  Washington,  D.  C,  the  condition  of  affairs  and  in  due 
time  received  the  pleasing  information  by  wire  from  her  hus- 
band that  I  should  proceed  at  once  and  draw  on  him  for  the 
amount.  After  overcoming  some  of  the  technical  difficulties 
in  the  way  of  securing  the  necessary  water  supply  from  the 
adjacent  Crawfish  Springs,  the  purchase  was  made  and  the 
'Leiter  Hospital"  has  become  a  beautiful  monument  to  the 
memory  of  a  distinguished  family  that  has  given  the  first  large 
donation  for  the  benefit  of  our  sick  citizen  soldiers  at  the  very 
beginning  of  the  Spanish-American  war.  May  this  noble 
example  find  many  imitators  ! 


i^iySiL§pPi 


Chickamauga,  Ga.,  June  22,  1898. 

CAMP    GEORGE   H.    THOMAS. 

Prom  early  dawn  until  taps,  Camp  Thomas  is  the  scene  of 
a  busy,  active  life.  It  is  the  gathering  point  of  the  largest 
army  concentrated  in  one  place  since  the  War  of  the  Rebellion. 
It  is  at  the  present  time  the  temporary  home  of  45,000  men 
representing  almost  every  State  in  the  Union.  Many  of  the 
regiments  are  short  of  their  quota,  and  recruits  to  the  number 
of  500  on  an  average  arrive  daily  to  complete  the  organization  of 
the  regiments  now  in  camp.  The  commander  of  the  whole 
army  in  camp  is  Major  General  John  R.  Brooke,  General  in 
Chief  in  charge  of  the  Department  of  the  Lakes.  He  came 
here  from  Chicago  with  his  entire  staff.  He  enjoys  the  repu- 
tation of  being  a  strict  disciplinarian  who  does  everything 
through  the  legitimate  military  channels.  The  greatest  sour- 
ces of  confusion  and  consternation  to  the  officers  of  the  vol- 
unteers from  civil  life  are  these  mysterious  military  channels 
which  extend  from  the  General's  tent  to  the  heads  of  the 
many  departments  in  Washington.  One  of  the  blue  books  in 
constant  use  by  officers,  high  and  low,  young  and  old,  is  the 
U.  S,  Army  Regulations,  1895.  The  thousands  of  questions 
asked  the  professional  soldier  daily  by  his  less  informed  volun- 
teer officer  are  answered  more  often  than  otherwise  by  "  Study 
the  Regulations,  Study  the  Regulations,  Study  the  Regula- 
tions." Such  advice,  as  a  rule,  is  more  easy  to  give  than  to 
follow  with  any  expectation  of  approval  at  headquarters.  The 
experience  here  has  satisfied  me  more  than  ever  that  the  Na- 
tional Guard  officers  need  more  thorough  training  in  execu- 
tive, clerical  work,  so  essential  in  the  efficient  management  of 
troops  at  home  and  in  the  field.  One  of  the  common  sights 
in  camp  is  to  see  an  officer  hide  himself  away  under  a  solitary 
tree  and  pore  over  a  work  on  tactics  or  the  much  feared  "  Reg- 
ulations." If  this  war  does  nothing  else  but  demonstrate 
to  our  people  and  to  the  legislators,  State  and  National, 
the  necessity  of  a  well  organized  militia  it  will  have  accom- 
plished   a    great    deal.     If    we   had  in    this  country,    as    we 


32 


ought  to  have,  a  well  organized,  well  equipped  militia  force  of 
200,(X>0  men,  we  would  have  been  in  possession  of  all  the  Span- 
ish islands  and  Spain  itself,  if  we  wanted  it,  long  ago.  As  it 
is,  it  takes  two  millions  a  day  and  the  hardest  kind  of  work  to 
bring  our  volunteers  into  fighting  trim.  The  officers  of  the 
regular  army  have  reason  to  be  thankful  to  Spain  for  having 
given  them  a  chance  to  fight.  They  have  been  looking  a  long 
time  anxiously  for  such  an  opportunity.  They  are  the  recog- 
nized salt  of  the  army.  The  Government  has  fully  recognized 
their  claims.  Nearly  every  day  the  newspapers  bring  columns 
of  names  of  lucky  officers  who  have  been  advanced  in  rank,  in 
fact  it  seems  almost  impossible  for  any  one  of  them  to  escape 
promotion  of  some  kind.  This  is  probably  as  it  should  be,  but 
occasionally  such  promotions  lead  to  giddy  heights.  To  make 
a  lieutenant  colonel  out  of  a  second  lieutenant  of  very  limited 
practical  experience  is  a  transition  of  doubtful  propriety  and 
often  followed  by  the  most  detrimental  results,  both  to  the 
over-ambitious  officer  and  the  over-confiding  troops  placed 
under  his  charge.  Officers  thus  honored  by  promotion  and 
assigned  to  the  army  of  volunteers  are,  as  a  rule,  more  anx- 
ious to  change  the  shoulder  straps  than  to  add  the  V.  to  the 
U.  S.  on  the  collar  of  the  blouse.  On  the  whole,  the  regular 
army  officers  are  perfect  gentlemen  and  great  favorites  in  the 
camp,  and  the  feeling  between  them  and  the  officers  from  civil 
life  is  of  a  most  cordial  nature. 

The  First  Army  Corps  under  General  Brooke  is  nearly  com- 
pleted. The  Third  Army  Corps  under  command  of  Major-Gen- 
eral  Wade  is  nearing  completion.,  The  Sixth  Army  Corps  is 
soon  to  be  organized  under  Major-General  James  H.  Wilson. 
General  Wilson  gained  an  enviable  reputation  during  the  late 
war  as  a  dashing  cavalry  officer  and  will  undoubtedly  make  a 
creditable  record  during  the  present  war  if  it  lasts  long  enough 
to  bring  his  army  into  the  field,  Lieut. -Colonel  Hartsuff,  an 
experienced  medical  officer  of  the  regular  army,  is  Surgeon-in- 
Chief  of  the  army  gathered  here,  and  as  such  is  attached  to 
the  statf  of  (ieneral  Brooke.  Lieut. -Colonel  Van  Iloff  is  Chief 
Surgeon  of  the  Third  Army  Corps,  and  has  worked  incessantly 
in  completing  the  organization  of  the  medical  department  under 
his  supervision.  He  is  regarded  as  one  of  the  ablest  executive 
officers  of  the  medical  service,  and  is  known  as  a  warm  friend 


33 


of  the  medical  officers  of  the  National  Guard.  He  has  from 
the  very  beginning  taken  a  deep  and  active  interest  in  the  work 
of  the  Association  of  Military  Surgeons  of  the  United  States. 
Every  medical  officer  of  the  Third  Army  Corps  should  con- 


Major-General  John  R.  Brooke. 
General  in  Chief  in  charge  of  the  Department  of  the  Lakes. 

sider  it  a  great  privilege  to  serve  under  Lieut.  -  Colonel  Van  Hoff . 
The  medical  department  of  the  First  Army  Corps  is  in  charge 
of  Lieut. -Colonel  Heidekoper  of  New  York,  a  hard-working, 
conscientious  officer.    Major  Kimball  of  Marion,  Ind.,  and  Ma- 


34 


jor  Woodbury  of  New  York,  have  reported  here  and  are  await- 
ing with  the  writer  the  formation  of  the  Sixth  Army  Corps. 
At  present  my  time  is  profitably  occupied  by  consultations  in 
the  camp  and  by  performing  operations  in  the  Leiter  General 
Hospital  and  the  St.  Vincent's  Hospital.  Chattanooga.  The  eve- 
nings are  occupied  by  giving  lectures  on  first  aid  to  the  Hospi- 
tal cori)S.  St.  Vincent's  Hospital  has  been  used  as  a  tempo- 
rary hospital  for  the  troops  until  the  Leiter  Hospital  was  in 
condition  to  receive  patients.  The  abandonment  of  regimen- 
tal hospitals  meets  with  the  same  opposition  here  as  elsewhere, 
but  the  wisdom  of  such  a  course  must  be  apparent  to  all  who 
have  had  experience  in  the  field.  Major  E,  C.  Carter,  U. 
S.  A.,  is  now  in  charge  of  the  Leiter  General  Hospital.  He  is 
one  of  the  busiest  men  in  the  camp.  He  is  in  every  way  ad- 
mirably adapted  for  the  position  he  now  occupies.  He  is 
straining  every  nerve  to  improve  and  equip  the  building  for  the 
accommodation  of  from  300  to  500  patiec^ts.  He  has  the  hearty 
co-operation  of  the  Surgeon-General  and  Colonel  Hartsuff 
in  pushing  the  work.  About  thirty  patients  are  at  present  in 
the  hospital  and  in  less  than  two  weeks  the  number  of  patients 
will  exceed  one  hundred.  Hospital  furniture  and  supplies  are 
arriving  every  day,  and  in  the  course  of  two  weeks  the  hospi- 
tal will  be  fully  equipped.  The  value  of  this  hospital  to  our 
sick  soldiers  can  not  be  overestimated.  Mrs.  Leiter  will  have 
the  respect  and  sincere  gratitude  of  every  one  of  the  inmates 
and  of  hundreds  yet  to  come.  Chickamauga  is  a  quiet  little 
country  hamlet  where  our  patients  can  enjoy  to  the  fullest  ex- 
tent what  they  are  so  much  in  need  of,  rest  and  quietude.  Six 
trained  nurses  have  been  sent  by  the  Surgeon-General  and  are 
now  on  duty.  With  the  increase  in  the  humber  of  patients 
more  will  be  sent.  A  corner  room  in  the  tower  on  the  second 
story  has  been  set  aside  as  an  operating  room  and  is  now  under- 
going the  necessary  repairs  to  adapt  it  for  this  purpose.  The 
first  operation  performed  in  this  hospital  was  for  empyema 
following  pneumonia.  Two  additional  cases  await  a  similar 
operation  during  the  course  of  the  week. 

CRAWFISH  SPRINGS. 

One  of  the  great  attractions  near  the  National  Park  and 
adjacent  to  the  Leiter  General  Hospital  is  the  famous  Crawfish 
Springs,     At  the  end  of  a  large  basin  and  at  the  base  of  a  rock 


35 


a  large  volume  of  water,  as  clear  as  a  crystal,  is  poured  out 
with  considerable  force.  This  spring  yields  62,(X)0,0()0  gallons 
of  water  in  twenty-four  hours.  The  temperature  of  the  water 
is  56  degrees  F.,  summer  and  winter  alike.     The  dam  a  little 


Maior-General  James  H.  Wilson. 


below  the  springs,  utilized  to  furnish  water  power  for  the  hotel, 
has  been  removed  for  the  reason  that  it  interfered  with  the 
supply  of  water,  deviating  it  evidently  through  subterranean 
channels  in  another  direction.  As  soon  as  the  property  was  trans- 
ferred to  Mrs.  Letter  for  Government  use  I  had  the  basin  cleaned 


36 


out  of  moss  and  dirt  by  a  detail  of  soldiers  furnished  by  the 
Fifth  Illinois  Infantry.  The  sides  of  the  hill  around  the  basin 
were  ditched  a  few  feet  above  the  level  of  the  water  for  the 
surpose  of  draining  the  surface  water  to  a  safe  distance  below 
the  springs.  The  Hospital  is  supplied  with  water  from  this 
spring.  Besides,  hundreds  of  barrels  of  water  are  brought  daily 
into  the  camp  by  mule  teams.  The  water  is  wholesome  and 
palatable. 

The  following  is  the  result  of  a  chemical  analysis  made  by 
a  competent  chemist : 

ANALYSIS  OF  CRAWFISH  SPRINGS  WATER. 

Bicarbonate  of  lime 0.6753 

Bicarbonate  of  magnesia 0.454^ 

Sodium  chlorid 0.856 

Potassium  chlorid 0.048 

Silica 0.0537 

Free  ammonia 0.0029 

Albuminoid  ammonia 0.0025 

Oxygen  absorbed 0.031 

The  presence  of  free  ammonia  and  albuminoid  of  ammonia, 
although  small  in  quantity,  led  us  to  suspicion  the  presence  of 
organic  matter  which  might  possibly  prove  to  be  a  source  of 
danger.  For  the  purpose  of  testing  the  water  still  further  as 
to  its  fitness  for  hospital  and  camp  use,  samples  were  sent  at 
three  different  times  to  the  professor  of  chemistry  in  the  Chat- 
tanooga Medical  College.  Dr.  H.  Berlin  made  a  very  careful 
chemic  analysis  and  bacteriologic  examination  with  the  result 
that  he  pronounced  the  water  free  from  dangerous  organic 
matter  and  pathogenic  microbes.  The  only  microbe  which  he 
was  able  to  cultivate  was  the  colon  bacillus,  and  the  presence 
of  this  microbe  could  be  readily  accounted  for  by  the  blocking 
of  the  sewer  pipe,  an  evil  which  was  promptly  removed.  The 
springs  would  furnish  an  ample  water  supply  for  the  whole 
army  if  the  (Jovernment  would  only  erect  a  pumping  station 
near  it,  a  project  which  is  now  under  serious  consideration. 
With  such  an  improvement  Camp  George  H.  Thomas  would  be 
one  of  the  most  salubrious  camping  places  in  the  United  States 
for  a  large  army.  The  intake  now  is  some  distance  below  the 
springs  where  the  How  of  water  is  impeded  by  a  dam  two  miles 
and  a  half   below  the  springs.     Above  the  dam  is  a  narrow 


37 


beautiful  lake  two  miles  and  a  half  in  length,  extending  to  near 
the  springe,  which  is  leased  by  the  Chickamauga  Fishing  Club. 

CHATTANOOGA    MEDICAL    SOCIETY. 

This  medical  society  meets  twice  every  month,  on  the  first 
and  third  Friday.  At  the  last  meeting  the  subject  selected  by 
the  committee   was   "The    Modern    Treatment    of    Gunshot 


Major-General  Joseph  C.  Breckinridge. 
Wounds  in  Military  Practice."  The  writer  was  invited  to  open 
the  discussion.  After  a  brief  resume  of  the  character  of  wounds 
inflicted  by  the  modern  bullet,  the  treatment  was  considered 
in  detail.  Special  stress  was  placed  upon  the  inutility  of  the 
ordinary  and  Nelaton's  probe  in  locating  and  finding  bullets 
lodged  in  the  body.     Attention  was  called  to  the  value  of  the 


38 


X  ray  as  a  substitute  for  the  probe  in  making  a  reliable  diag- 
nosis. The  use  of  the  bullet  probe  on  the  battlefield  was  con- 
demned and  the  advice  given  that  bullet  wounds  should  be 
hermetically  sealed  with  the  first  aid  package,  which  should  con- 
tain an  antiseptic  powder  composed  of  boracic  acid  and  salicy- 
lic acid  (4  :li,  and  no  exploration  made  until  the  patient  reaches 
the  field  hospital,  where  all  facilities  for  aseptic  surgery  and 
the  necessary  instruments  for  diagnosis  and  operation  should 
be  at  hand.  A  new  bullet  probe  and  bullet  forceps  devised  by 
the  writer  were  exhibited  and  their  manner  of  use  explained. 
The  balance  of  the  paper  treated  of  gunshot  wounds  of  the 
extremities,  cranium,  chest  and  abdomen.  For  want  of  time 
consideration  of  the  last  subject,  "Gunshot  Wounds  of  the 
Abdomen,"  was  postponed  until  the  next  meeting.  Invitations 
to  attend  the  meeting  were  sent  to  the  military  surgeons  in 
camp,  consequently  the  attendance  was  large  and  the  discus- 
sion became  general  and  proved  of  interest  to  all  present. 
Considering  that  Chattanooga  has  only  40,000  inhabitants  and 
that  the  average  attendance  at  these  meetings  on  ordinary  oc- 
casions is  never  less  than  from  thirty-five  to  forty,  is  the  surest 
indications  that  our  colleagues  in  this  city  take  an  active 
interest  in  the  scientific  work  of  the  profession. 

AMUSEMENTS. 

The  civilian  soldier  finds  it  difficult  to  satisfy  his  mind  and 
body  with  what  is  required  of  him  in  camp  life.  But  a  few 
weeks  ago  he  was  a  professional  man,  a  clerk,  teacher,  or  left 
the  school,  workshop  and  plow,  and  now  it  is  hard  for  him  to 
imagine  that  he  should  not  be  kept  busy  from  sunrise  to  sunset. 
He  is  only  too  anxious  to  drill  in  sunshine  or  rain,  and  considers 
it  a  privilege  to  do  guard  duty,  where  his  power  and  military 
significance  can  be  made  to  appear  at  greatest  advantage.  He 
finds  it  difficult  to  occupy  his  many  leisure  hours  in  a  profitable 
manner.  To  the  credit  of  our  soldiers  it  must  be  said  that 
evidences  of  intemperance  are  rarely  seen  in  camp.  Temperance 
canteens  are  common  and  are  better  patronized  than  those  in 
which  beer  is  sold.  1  have  not  seen  an  intoxicated  soldier  since 
I  arrived  in  camp.  The  more  common  amusement  of  the  soldiers 
during  the  heat  of  the  day,  between  10  a.m.  and  .3  p.m.,  between 
drill  hours,  consists  in  reading,  writing  letters,  playing  cards, 
and  the  college  boys  are  bound  to  play  base-  or  football.     The 


39 


chaplains  make  themselves  useful  not  only  in  caring  for  the 
spiritual  welfare  of  their  soldiers,  but  they  also  look  after  their 
intellectual  interests.  They  extemporize  reading-rooms  and 
supply  them  with  writing  and  reading  material.  These  reading 
tents  are  very  popular,  and  when  the  men  are  off  duty  they  are 
always  crowded.  The  many  regimental  bands  furnish  excellent 
music,  which  does  so  much  in  cheering  up  and  amusing  the 
soldiers.  Two  theaters  have  sprung  up  in  the  camp,  mushroom- 
like. Performances  are  given  in  the  afternoon  and  evening. 
The  admission  fee  is  twenty-five  cents,  box  seats  fifty  cents,  I 
have  been  told  by  those  who  have  been  in  the  habit  of  attending 
that  the  plays  are  good  and  that  the  patrons  are  made  to  feel 
that  they  have  received  their  money's  worth, 

RED    CROSS    ASSOCIATION, 

The  Medical  Department  during  the  present  war  is  in  a  con- 
dition fairly  well  prepared  to  supply  the  sick  and  wounded  with 
the  necessary  instruments,  medicines  and  food.  There  will  be 
only  a  very  limited  field  of  usefulness  for  the  Red  Cross  Asso- 
ciation to  fill  in  defects  here  and  there  as  occasion  and  circum- 
stances may  require.  The  work  of  the  Red  Cross  Association 
is,  however,  recognized  by  the  War  Department,  as  becomes 
evident  from  a  circular  letter  received  a  few  days  ago  from  the 
Surgeon- General : 

Sdkgeon- General's  Office,  Washington,  June  9,  1898, 
Lieutenant- Colonel  Nicholas  Senn,  Chief  Surgeon  U.  S.  Vol- 
unteers, Sixth  Army  Corps,  Chickamauga  Park,  Ga. 
Sir: — The  Secretary  of  War  has  approved  the  following 
proposition  made  by  the  American  National  Red  Cross  Associ- 
ation, and  the  chief  surgeons  of  the  Army  corps  and  divisions 
will  cooperate  with  the  authorized  agents  of  this  Association 
for  the  purposes  indicated  : 

"  We  can  put  any  desired  amount  of  hospital  supplies— ice, 
malted  milk,  condensed  milk,  Mellin's  food,  etc,  into  any  of 
the  volunteer  camps  in  a  few  hours.  Will  you  be  kind  enough 
to  bring  this  letter  to  the  attention  of  Secretary  Alger  and  ask 
him  if  there  is  any  objection  to  our  appointing  a  Red  Cross 
representative  to  report  to  the  commanding  officer  and  the 
chief  surgeon  in  every  camp,  confer  with  them  as  to  their 
immediate  needs  and,  if  anything  of  any  kind  is  wanting,  open 
there  a  Red  Cross  station  and  send  in  the  supplies.  We  can 
do  this,  not  in  a  few  weeks  or  a  few  days,  but  in  a  few  hours, 
and  can  furnish  any  quantity  of  any  desired  luxury  or  delicacy 
for  hospital  use.    We  hereby  tender  our  aid  and  put  our  organ- 


40 


ization  at  the  War  Department's  service  for  co-operation  in  the 
field."  Very  respectfully, 

Geo.  M.  Sternberg,  Surgeon-General  U.  S.  A. 

It  was  prudent  and  wise  that  the  Surgeon-General  and  the 
Secretary  of  War  granted  this  modest  request.  Dr.  Gill  of 
New  York  represents  the  Red  Cross  Association  here.  He 
arrived  a  few  days  ago  and  intends  to  erect  a  frame  building 
near  the  general  headquarters  as  a  storehouse  for  the  supplies. 
He  possesses  excellent  executive  abilities  combined  with  mod- 
esty, which  will  ensure  him  a  wide  avenue  of  usefulness  and 
the  hearty  appreciation  of  the  medical  officers.  In  my  next 
communication  I  will  speak  of  the  hospital  corps,  its  organiza- 
tion and  scope  of  work  in  actual  warfare. 


ASSIGNED  TO  A  NEW  FIELD. 


War  always  has  been  and  always  will  be  a  cruel  thing.  The 
very  object  of  war  is  to  kill,  disable,  maim  and  starve  until  the 
result  of  the  contest  shall  decide  the  issue  by  demonstrating 
the  superiority  of  one  army  over  the  other  in  number,  courage 
or  skill  of  warfare.  "  The  battle  is  the  Lord's,"  but  victory  is 
not  always  on  the  side  of  justice.  The  Lord  teaches,  rules  and 
benefits  the  children  of  men  now,  as  during  the  time  of  the 
prophets,  as  often  by  defeat  as  victory.  The  God  of  battles 
has  ways  and  means  often  impossible  to  comprehend,  but  they 
always  lead  to  results  beneficial  to  mankind.  The  terrors  and 
sufferings  of  war  are  the  prices  paid  for  defeat  as  well  as  vic- 
tory. The  wonderful  improvements  made  in  weapons  and  pro- 
jectiles during  the  last  quarter  of  a  century  have  made  modern 
warfare  more  destructive  if  not  less  cruel.  It  is  difficult  to 
foretell  the  relative  number  of  dead  and  wounded  in  the  engage- 
ments of  the  future.  Reliable  information  on  the  subject  must 
come  from  actual  observation  on  a  large  scale  on  the  battlefield 
and  not  from  the  results  of  experiments  on  the  lower  animals 
and  the  cadaver.  Warfare  has  become  a  science  and  an  art, 
and  victory  will  depend  as  much  on  the  skill  and  foresight  in 
strategy  of  the  commanding  officers  as  the  endurance  and  valor 
of  the  troops.  The  long  range  rifles  and  the  better  marksman- 
ship of  the  average  soldier  will  increase  the  distance  between 
the  fighting  lines  and  give  the  commanding  officers  better 
opportunities  for  the  exercise  of  their  skill  in  maneuvering  the 
troops.  In  every  respect  war  will  and  must  assume  more  sci- 
entific aspects  for  the  display  of  skill.  What  the  improve- 
ments will  be  can  only  be  determined  by  experience  on  a  large 
scale.  The  rapid  mobilization  of  troops,  supply  of  ammunition 
along  the  line  of  battle,  flank  movements,  the  quick  digging 
of  shallow  entrenchments  for  the  protection  of  the  soldiers  in 
line  of  battle,  are  some  of  the  important  subjects  which  are 
engaging  the  minds  of  our  wide  awake  military  officers  and 
which  await  a  satisfactory  solution  by  as  yet  an   unknown 


42 


second  Napoleon.  Let  us  hope  that  this  important  person  is 
now  in  existence,  an  American  citizen  and  now  engaged  in  the 
present  war  with  Spain. 

HOSPITAL  CORPS. 

The  humane  side  of  the  present  methods  of  warfare  is  best 
shown  by  the  organization  of  an  efficient  hospital  and  ambu- 
lance corps.  The  sick  and  wounded  of  the  great  war  of  the 
rebellion  suffered  indescribable  pain  and  agony  owing  to  inad- 
equate provisions  for  transportation,  first  aid  and  nursing  by 


Private,  hospital  corps  U.S.  Army, 
field  equipment  (front  view). 


Private,  hospital  corps  U.S.  Army, 
field  equipment  trear  view). 


men  detailed  for  this  special  purpose.  Our  sick  and  wounded 
can  look  forward  more  hopefully  for  more  prompt  and  efficient 
treatment.  The  Government,  through  the  Surgeon- General 
and  Secretary  of  War,  is  making  ample  preparations  for  the 
prompt  and  efficient  treatment  of  those  requiring  medical  or 
surgical  aid.  The  prevention  of  disease  by  the  employment  of 
improved  hygienic   and   sanitary  measures  will  do  much   in 


43 


minimizing  the  number  of  ignominious  deaths  in  the  field  and 
general  hospitals  and  in  maintaining  the  full  fighting  force. 
The  need  of  a  well  organized  and  well  equipped  hospital  corps 
became  apparent  during  our  late  war,  but  it  was  many  years 
after  the  Union  was  restored  before  the  necessary  legislation 
was  effected  which  brought  it  into  existence.  The  Hospital 
Corps  in  the  United  States  Army  was  created  by  an  act  of 
Congress  approved  March  1,  1887. 

The  law  under  which  the  Hospital  Corps  was  established 
and  as  revised  by  March  16,  1895,  and  March  16,  1896,  reads  as 
follows  : 

(The  Military  Laws  of  the  United  States,  1897.) 

"673.  That  the  Hospital  Corps  of  the  United  States  Army 
shall  consist  of  hospital  stewards,  acting  hospital  stewards  and 
privates  ;  and  all  necessary  hospital  services  in  garrison,  camp 
or  field  (including  ambulance  service)  shall  be  performed  by 
the  members  thereof,  who  shall  be  regularly  enlisted  in  the 
military  service.  Said  Corps  shall  be  permanently  attached  to 
the  Medical  Department,  and  shall  not  be  included  in  the 
effective  strength  of  the  Army  nor  counted  as  a  part  of  the 
enlisted  force  provided  by  law. 

"674:.  That  the  Secretary  of  War  is  empowered  to  appoint 
as  many  hospital  stewards  as,  in  his  judgment,  the  service  may 
require  ;  but  not  more  than  one  hospital  steward  shall  be  sta- 
tioned at  any  port  or  place  without  special  authority  of  the 
Secretary  of  War.  That  there  shall  be  no  appointments  of 
hospital  stewards  until  the  number  of  hospital  stewards  shall 
be  reduced  below  one  hundred,  and  thereafter  the  number  of 
such  officers  shall  not  exceed  one  hundred. 

"675.  That  the  pay  of  the  hospital  stewards  shall  be  forty- 
five  dollars  per  month,  with  the  increase  on  account  of  length 
of  service  as  is  now,  or  may  hereafter  be  allowed,  by  length  of 
service,  as  is  now  or  may  hereafter  be  allowed  by  law,  to  other 
enlisted  men.  They  shall  have  rank  with  ordnance  sergeants 
and  be  entitled  to  all  the  allowances  appertaining  to  that  grade. 

"676.  That  no  person  shall  be  appointed  a  hospital  steward 
unless  he  shall  have  passed  a  satisfactory  examination  before 
a  board  of  one  or  more  medical  officers  as  to  his  qualification 
for  the  position,  and  demonstrated  his  fitness  therefor  by 
service  of  not  less  than  twelve  months  as  acting  hospital  stew- 
ard ;  and  no  person  shall  be  designated  for  such  examination 
except  by  written  authority  of  the  Surgeon-General, 

"677.  That  the  Secretary  of  War  is  empowered  to  enlist  or 
cause  to  be  enlisted,  as  many  privates  of  the  Hospital  Corps  as 
the  service  may  require,  and  to  limit  or  fix  the  number,  and 
make  such  regulations  for  their  government  as  may  be  neces- 
sary ;  and  any  enlisted  man  in  the  army  shall  be  eligible  for 


44 


transfer  to  the  Hospital  Corps  as  a  private.  They  shall  per- 
form duty  as  wardmasters,  cooks,  nurses,  and  attendants  in 
hospital,  and  as  stretcher-bearers,  litter-bearers  and  ambu- 
lance attendants  in  the  field,  and  such  other  duties  as  may  by 
proper  authority  be  required  of  them, 

"678.     That  the  pay  of  privates  of  the  Hospital  Corps  shall 


Litter  drill. 

be  eighteen  dollars  per  month,  with  the  increase  on  account  of 
length  of  service  as  is  now  or  may  be  hereafter  allowed  by  law 
to  other  enlisted  men  ;  they  shall  be  entitled  to  the  same  allow- 
ances as  a  corporal  of  the  arm  of  service  with  which  on  duty. 
"679.  That  privates  of  the  Hospital  Corps  may' be  detailed 
as  acting  hospital  stewards  by  the  Secretary  of  War  upon  the 
recommendation  of  the  Surgeon-General  whenever  the  necessi- 


45 


ties  of  the  service  require  it ;  and  while  so  detailed  their  pay 
shall  be  twenty-five  dollars  per  month,  with  increase  as  above 
stated.  Acting  hospital  stewards,  when  educated  in  the  duties 
of  the  position,  may  be  eligible  for  examination  for  appoint- 
ment as  hospital  stewards  as  above  provided." 

Since  the  original  law  providing  for  a  hospital  corps  was 
passed  many  new  features  have  been  added  which  have  made 
this  branch  of  the  military  service  more  efficient. 

The  pay  of  members  of  the  Hospital  Corps  is  according  to 
grade,  as  follows  per  month:  Hospital  steward,  $45;  acting 
hospital  steward,  $25 ;  private,  §18. 

To  the  rates  of  pay  enumerated  above,  20  per  cent,  is  added 
in  time  of  war. 

During  the  present  war  the  commander  of  an  army  corps,  or 
of  a  division,  or  of  a  brigade  acting  independently  of  a  corps, 
has  full  control  of  enlistments  for  the  Hospital  Corps  within 
his  command,  and  of  the  detail  of  acting  hospital  stewards  and 
the  appointment  of  hospital  stewards.  The  Hospital  Corps 
force  of  the  present  war  is  made  up  three  per  cent,  of  the  pri- 
vates obtained  by  special  enlistment  or  transfer  from  the  line, 
that  is,  a  regiment  of  1000  men  is  entitled  to  30  men  for  the 
Hospital  Corps.  The  allowance  for  horses,  wheel  transporta- 
tion and  tentage  is  ample,  as  will  be  seen  from  the  following 
order  recently  issued  by  the  War  Department : 

General  Orders.)  HEADQUARTERS  OF  THE  ARMY, 

V  Adjutant  General's  Office, 

No.  76.  )  Washington,  June  22,  1898. 

1.— By  direction  of  the  Secretary  of  War,  the  following  allowance  of 
horses  for  mounts,  wheel  transportation,  tentage,  etc.,  for  the  Medical 
Department  of  the  Army  in  the  field  is  authorized  : 
Horses  for  Mounts. 


To  each  regiment  of  infantry 

To  each  artillery  battalion  (S  light  bat- 
teries)  

To  each  cavalry  regiment 

To  each  corps  headquarters 

To  each  division  headquarters  .   .   .   . 

To  each  brigade  headquarters 

To  each  division  ambulance  company 

To  each  corps  reserve  ambulance  com 
pany 

To  each  division  field  hospital  .   .   .   . 

To  each  corps  reserve  hospital  .  . 


Hospital 
stewards. 


Acting 
hospital 
stewards. 


Privates. 


Wheel  transportation.— One  ambulance  to  400  men  of  the  effective  force. 
One  4-horse  wagon  to  (iOO  men  of  the  effective  force.  One  -l-horse  wagon 
to  each  brigade. 


46 


Tentagt.— For  each  ambulance  company:  17  common  tents  for  pri- 
vates; 2  common  tents  for  noncommissionetl  officers.  For  each  divi- 
sion field  hospital:  15  common  tents  for  privates;  2  common  tents  for 
noncommissioned  officers;  1  common  tent  for  supplies.  Hospital  tents 
on  a  basis  of  6  patients  (beds)  to  each  tent.  Hand  litters,  with  slings, 
to  be  furnished  by  the  Quartermaster's  Department:  1  for  each  com- 
pany; 2  for  each  ambulance. 

Requisitions  for  the  necessary  articles  of  camp  and  garrison  equipage, 
tools,  etc.,  will  be  based  on  the  official  allowances  for  companies  of 
infantry. 

Requisitions  for  the  before  mentioned  supplies  will  be  sent  in  sep- 
arately for  divisio7is, -with  statement  whether  or  not  the  division  organi- 
zation is  complete. 

Horses  and  wheel  transportation  will  be  furnished  by  the  Quarter 
master's  Department,  and  horse  equipments  by  the  Ordnance  Depart- 
ment. 

II.— Commanding  Generals  of  Army  Corps  are  directed  to  detail,  upon 
the  application  of  Chief  Surgeons  of  Corps,  two  officers  not  above  the 
grade  of  first  lieutenant  for  duty  as  Acting  Assistant  Quartermasters 
with  the  medical  service  of  each  division. 

By  Command  of  Major  General  Miles: 

E.G.  CORBIN, 

Adjutant  General. 


Litter  drill. 


As  usual,  many  difficulties  have  presented  themselves  in  the 
way  of  securing  the  necessary  material  both  in  quantity  and 
quality,  for  the  Hospital  Corps  during  the  present  campaign. 


47 


The  commanding  officers  are  always  averse  to  lose  the  most 
desirable  men  of  the  line.  I  have  reason  to  believe  that  at  the 
present  time  the  importance  of  a  good  Hospital  Corps  is  appre- 


Travois. 


ciated  more  than  ever  by  the  commanding  officers.  The  field 
officers  have  co-operated  with  the  corps  surgeons  in  the  selec- 
tion of  the  best  men  for  this  special  service.  The  work  of 
organization  has  progressed  slowly,  but  on  the  whole  in  a  sat- 


48 


isfactory  manner.  The  enormous  demand  for  equipments  and 
the  sudden  mobilization  of  troops  have  contributed  much  in 
retarding  the  organization  and  instruction  of  the  Hospital 
Corps.  The  designation  of  the  Corps  as  a  Hospital  Corps  does 
not  convey  the  proper  meaning  of  the  manifold  purposes  for 
which  the  men  are  enlisted  and  transferred,  and  has  been  the 
means  of  misleading  many  a  patriotic  doctor  and  medical  stu- 
dent now  engaged  in  this  branch  of  military  service.  Many 
complaints  are  heard  because  instead  of  doing  hospital  duty 
proper  the  men  are  made  to  cook,  drive  ambulances,  chop  wood, 
dig  sinks  and  haul  water.  There  are  today  too  many  doctors 
and  medical  students  in  the  Hospital  Corps.  The  duties  of 
the  Hospital  Corps  are  manifold,  and  in  their  proper  discharge 
requires  more  skilled  artisans  than  medical  men.  A  good  Hos- 
pital Corps  should  consist  largely  of  young,  bright,  intelligent, 
robust  men  skilled  as  carpenters,  cooks,  blacksmiths,  stenog- 
raphers, photographers,  ambulance  drivers,  tailors,  shoemakers 
and  other  trades.  Doctors  and  medical  students  should  be  in 
the  minority,  and  ought  not  to  exceed  twenty-five  per  cent, 
of  the  non-combatant  force.  If  the  legitimate  function  of 
the  Hospital  Corps  were  better  understood  there  would  be 
fewer  applications  for  this  service  on  the  part  of  profes- 
sional men.  The  general  impression  prevails  that  the  duties 
of  the  members  of  the  Hospital  Corps  are  less  onerous 
than  those  of  the  private  soldier  of  the  line.  It  is  difficult  to 
conceive  how  such  an  idea  could  have  originated.  It  is  also 
understood  that  the  non-combatant  soldier  is  exposed  to  less 
risk  of  life  than  his  comrade  of  the  line,  when  the  fact  is  ap- 
parent that  in  addition  to  the  ordinary  dangers  incident  to 
warfare,  he  is  more  exposed  to  the  greatest  source  of  danger — 
disease.  The  nursing  in  the  field  hospital  is  done  exclusively 
by  the  Hospital  Corps  men,  and  involves  much  loss  of  sleep 
and  constant  care  and  attention.  The  transportation  of  sick 
and  wounded  is  a  task  requiring  good  judgment,  promptitude 
and  care.  A  combination  of  firmness  and  gentleness,  thought- 
fulness  of  action  and  a  determination  to  perform  duty  regard- 
less of  rest  and  comfort,  is  an  essential  element  of  success  in 
the  work  of  every  Hospital  Corps  man.  The  climatic  influence, 
the  prevalence  of  tropical  diseases  will  tax  to  the  utmost  the 
resources  of  the  Hospital  Corps  during  the  present  war  with 


49 


Spain.  That  the  work  will  be  well  and  cheerfully  done  I  have  no 
doubt,  judging  from  my  observations  during  the  last  two  months. 
The  American  people  expect  that  the  sick  and  wounded  of 
this  war  shall  receive  the  best  possible  attention,  and  in  this 
they  will  not  be  disappointed.  The  Government,  although 
sometimes  necessarily  tardy,  is  willing  and  anxious  to  do  all 
in  its  power  to  alleviate  the  horrors  of  this  war,  and  in  this 
humane  intention  it  will  receive  the  hearty  co-operation  of  the 
Hospital  Corps.  The  writer  has  been  permanently  detached 
from  the  Sixth  Army  Corps  now  at  Chickamauga  by  a  recent 
order,  and  is  now  on  his  way  to  Santiago  de  Cuba  on  special 
duty.  He  goes  to  the  front  as  Chief  of  the  Operating  StafiP 
with  the  troops  in  the  field.  For  the  purpose  of  informing  my 
many  friends  among  your  readers  what  I  am  expected  to 
do,  I  append  a  copy  of  the  letter  assigning  me  to  my  new  field 
of  labor. 

HEADQUARTERS    OF    THE    ARMY. 

Washington,  D.  C,  June  29,  1898. 
Lieutenant-Colonel  Nicholas  Senn,  U.  S.  V.,   Chief  of  the 

Operating  Staff. 

Sir  .-—In  assigning  you  as  Chief  of  \he  Operating  Staff,  the 
Major  General  Commanding  the  Army  directs  me  to  say  that, 
at  the  several  points  to  which  you  may  be  assigned  to  duty, 
you  will  confer  with  the  Chief  Surgeon  of  the  Corps  engaged 
as  to  the  means  by  which  you  may  consult  with  and  advise  the 
medical  officers  serving  with  that  army  regarding  the  clinical 
features  of  their  professional  work  ;  that  you  will  recommend 
such  methods,  either  by  lectures  or  operative  demonstration, 
as  may  in  your  judgment  be  best  suited  to  accomplishing  the 
purpose  in  hand  ;  that  you  will  take  the  necessary  steps  for 
collecting  data  upon  which  the  clinical  and  pathologic  records 
of  the  field  and  hospital  service  may  be  classified,  and  from 
which  the  future  medical  and  surgical  history  of  this  war  may 
be  prepared.  Your  present  assignment  will  be  for  duty  with 
the  Fifth  Army  Corps,  now  operating  before  Santiago  de  Cuba, 
and  at  such  future  time  as  the  General  Commanding  may 
decide,  you  will  be  transferred  to  other  points  where  active 
military  operations  are  progressing. 

Very  respectfully, 

Col.  Chas.  R.  Greenleaf, 
Asst.  Surg.-Genl.  U.  S.  A.,  Chief  Surgeon,  Army  in  the  Field. 

I  hope  I  will  reach  Santiago  before  surrrender  and  enter  it 
with  our  victorious  troops.     My  address  for  the  present  will  be 
Fifth  Army  Corps,  Santiago,  Cuba. 

My  next  communication  will  be  from  the  seat  of  war. 


THE  FLOATINC;  HOSPITALS. 

Off  Santiago  de  Cuba,  July  7,  1898. 
The  government,  the  different  charitable  societies,  local, 
State  and  general,  and  the  people,  have  from  the  very  begin- 
ning of  this  war  vied  with  each  other  in  adopting  and  carrying 
into  effect  means  and  measures  to  provide  comfort  and  efficient 
treatment  for  the  sick  and  wounded.  A  commendable  unity 
and  harmony  of  action  prevails  throughout  the  entire  country 
to  bring  about  the  best  results.  Desultory  action,  so  common 
during  the  War  of  the  Rebellion  and  that  did  so  much  in 
retarding  the  philanthropic  work  at  that  time,  has  largely 
given  way  to  well  organized,  systematic  efforts  which  will  be 
sure  to  result  in  the  greatest  amount  of  good  to  all  in  need  of 
such  assistance.  The  patriotism  of  the  people  is  only  equaled 
by  their  generosity  to  those  who  are  now  engaged  in  the 
defense  of  the  honor  and  dignity  of  their  country.  The  out- 
side world  will  watch  the  progress  and  extent  of  the  humani- 
tarian work  displayed  during  this  war  with  as  keen  an  interest 
and  degree  of  admiration  as  the  victories  of  our  army.  The 
collection  and  distribution  of  funds,  clothing,  delicacies  and 
hospital  supplies  is  in  the  hands  of  responsible  persons,  and 
the  liberal  donors  can  be  assured  that  the  articles  contributed 
will  reach  the  intended  destination.  Many  of  the  railway  cor- 
porations have  shown  a  laudable  willingness  to  forward  con- 
tributions of  this  kind  at  greatly  reduced  rates,  a  concession 
which  will  materially  increase  the  usefulness  of  the  various 
societies  which  have  been  or  will  be  organized  throughout  the 
land  for  the  distinct  purpose  of  aiding  the  government  in  prop- 
erly caring  for  those  who  have  been  disabled  from  injury  or  dis- 
ease. Efforts  in  this  direction  are  best  calculated  to  stimulate 
the  patriotism  and  heroism  of  our  soldiers  in  the  field.  One  of 
the  noblest  undertakings  for  this  purpose  is  the  action  of  the 
government  in  the  recent  purchase  and  outfitting  of  two  large 
ocean  vessels  for  hospital  and  ambulance  use.  The  Navy  has 
the  Solace,  and  the  Relief,  now  under  sail  for  the  seat  of  war, 
is  intended  for  the  Army.     The  seat  of  war  makes  the  use  of 


51 


these  ships  an  absolute  necessity  for  the  proper  care  of  the 
sick  and  wounded.  Both  of  these  ships  are  floating  hospitals 
supplied  with  all  the  facilities  of  a  modern  hospital. 

Tlie  Hospital  Ship  ''Relief.'' — This  communication  is  written 
on  board  the  hospital  ship  Belief,  on  its  first  trip  to  the  seat 
of  war.  The  ship  started  from  New  York,  July  2,  and  called 
at  Fortress  Monroe  in  the  afternoon  of  the  following  day  for 
the  purpose  of  taking  on  board  a  number  of  surgeons,  inclu- 
ding the  writer.  Surgeon  General  Sternberg  awaited  her  arri- 
val, and  made  a  thorough  inspection  before  her  departure. 
The  name  of  the  ship  appears  particularly  appropriate  from  the 
conditions  under  which  we  left  Fortress  Monroe,  Sunday,  July 
3.  Shortly  before  leaving  Fortress  Monroe  cable  messages  an- 
nounced that  fierce  fighting  was  in  progress  on  the  third  day 
of  the  battle  of  Santiago.  They  also  announced  to  the  anx- 
ious crowd  that  gathered  around  the  bulletin  boards  at  the 
hotel  Chamberlin,  that  the  number  of  killed  and  wounded  on 
our  side  had  reached  the  neighborhood  of  1200,  and  that  the 
enemy  showed  greater  strength  and  resistance  than  had  been 
anticipated.  General  Shafter,  in  command  of  the  invading 
army,  had  sent  a  telegram  to  New  York  asking  for  the  imme- 
diate despatch  of  the  Relief.  There  can  be  no  doubt  but 
that  the  appearance  of  the  boat  is  eagerly  looked  for  at  the 
seat  of  war,  and  that  upon  her  arrival  she  will  merit  the  name 
she  bears.  The  Ileli'^f  was  formerly  the  John  Englis,  and  was 
purchased  by  the  Government,  some  six  weeks  ago,  from  the 
Maine  Steamship  Line,  for  $450,000.  She  was  the  sister  ship 
of  Horatio  Hall,  and  was  used  a  year  and  a  half  as  a  coast 
liner  between  New  York  and  Portland,  Maine.  She  was  built 
by  the  Delaware  River  Iron  Ship  Building  and  Engine  Works, 
Chester,  Delaware,  in  1896.  She  was  well  adapted  for  the 
coast  service,  and  it  was  a  rare  opportunity  when  she  was 
secured  for  Government  service.  The  vessel  is  300  feet  in 
length,  46  feet  in  width,  draws  15  feet  of  water  forward  and 
161^  feet  aft,  and  has  an  averafge  speed  of  14  knots  an  hour. 
She  carries  two  masts,  one  smoke-stack,  and  is  supplied  with 
large  ventilators.  The  latter  are  of  especial  importance  after 
her  reconstruction  into  a  hospital  ship.  Major  Torrey,  Sur- 
geon U.  S.,  formerly  stationed  at  West  Point,  is  in  command 
of  the  ship,  and  had  charge  of  the  work  of  reconstruction  in 


52 


making  the  necessary  changes  in  adapting  her  for  hospital  use. 
Many  important  changes  in  the  interior  of  the  ship  had  to  be 
made  in  transforming  an  ordinary  passenger  steamer  into  a 
hospital  ship.  The  major  has  spent  six  anxious,  trying  weeks 
in  accomplishing  this.  He  availed  himself  of  the  valuable  ser- 
vices of  Naval  Constructor  Bowles.  The  work  was  done  at  the 
foot  of  Ninth  street,  New  York,  and  -.vas  watched  with  great 
interest  by  the  public  and  the  medical  profession  in  that  city 
and  surrounding  towns.  Many  of  the  staterooms  had  to  be 
removed  to  make  space  for  five  capacious  wards.  About  650 
men  were  employed  night  and  day  in  pushing  the  work  to  com- 
pletion as  rapidly  as  possible.  American  pluck  and  energy 
were  well  displayed  in  completing  the  herculean  task  in  four 
weeks.  The  entire  expense  of  reconstruction  will  reach  nearly 
8150,000,  so  that  the  ship  costs  the  Government  about  ^600,000. 
I  doubt  if  any  other  equal  sum  for  any  other  purpose  will  do 
so  much  for  our  army  as  this  floating  house  for  the  disabled 
soldiers. 

The  interior  of  the  ship  is  so  arranged  that  every  nook  and 
corner  can  be  utilized  to  advantage.  On  the  hurricane  deck 
forward  is  the  search-light  on  the  pilot  house,  the  pilot  house, 
pilot's  and  ship  oflBcers  rooms.  Center  and  aft  are  canopied 
for  convalescents,  and  are  well  supplied  with  long  wooden 
benches  and  steamer  chairs.  Eight  life  boats  and  four  rafts 
constitute  the  life-saving  outfit.  There  are  also  two  steam 
launches  28  feet  in  length  with  a  speed  of  nine  knots  an  hour. 
The  upper  saloon  deck  is  intended  for  medical  wards  mainly. 
Ward  No.  1  is  forward  and  has  82  beds.  The  iron  bedsteads  are 
of  special  construction,  securely  fastened  to  the  floor.  The 
cots  in  use  are  iron  framed  double-deck  beds  of  single  width, 
with  wire  spring  mattress  and  adjustable  side  rails.  Cotton 
mattress,  linen  sheet,  two  blankets  and  two  horsehair  pillows 
constitute  the  bed  proper.  Each  bed  has  a  wire  basket  attached 
for  dressing  material  ana  medicines. 

This  ward  is  sujjplied  with  two  toilet  rooms,  a  stationary 
bath  tub  and  sink  in  middle  of  ward,  with  adjustable  canvas 
screen.  Provision  has  also  been  made  here  for  hot  and  cold 
water  shower  bath.  The  room  is  lighted  by  four  reflectors 
with  six  incandescent  burners  to  each,  and  a  number  of  green 
shaded  incandescent  burners.     Four  electric  fans  will  prove  a 


53 


source  of  comfort  during  hot  weather.  The  center  of  this  floor 
is  devoted  to  state  rooms  for  the  female  nurses,  mess  room  for 
ward  No.  1,  and  a  large  pantry  containing  tableware  and  facil 
ities  for  preparing  special  diet.  Ward  No.  2  aft  end  of  the  ship 
with  a  capacity  of  Gi  beds  is  connected  by  a  hatchway  with 
ward  No.  4  below.  Bath,  toilet  rooms,  electric  lighting  and 
fans  same  as  in  ward  No.  1.  Forward  on  lower  saloon  deck 
are  the  sailor's  quarters,  offices,  sleeping  apartments  and  mess 
room  for  the  medical  officers,  medical  library  and  a  small 
ward  of  28  beds,  well  lighted  and  ventilated.  In  the  center  of 
this  deck  is  the  kitchen  and  mess  room  for  the  hospital  corps 
and  male  nurses.  At  the  entrance  of  the  gangway  and  in  a 
corner  of  the  large  surgical  ward  with  74  beds  is  the  operating 
room.  This  room  is  large  enough  for  all  practical  purposes, 
and  contains  two  operating  tables,  a  high  pressure  steam  ster- 
ilizer, reagent  and  dressing  cases,  stationary  wash  stand,  two 
instrument  cases,  two  formalin  sterilizers  and  two  electric  fans. 
The  floor  is  made  of  interlocking  rubber  tiles.  The  fourth  ward 
is  well  lighted  and  ventilated.  On  one  side  of  this  ward  are 
stationed  a  static  and  X  ray  apparatus  under  the  management 
of  Dr.  Gray. 

On  the  lower  deck  forward  is  the  fireman's  forecastle  (27 
beds),  an  ice  machine  with  a  capacity  of  a  ton  and  a  half  a  day, 
a  refrigerator  and  an  apparatus  for  manufacturing  carbonated 
water  at  the  rate  of  100  bottles  an  hour,  a  water  condenser 
(sixty  gallons  an  hour)  and  a  sterilizer  (carriage  4  feet,  6  inches 
by  8  feet,  6  inches,  which  can  be  used  for  the  disinfection  of 
large  articles  by,  a,  steam  under  ten  pounds  of  pressure  at 
240 P.,  b,  formaldehyde,  c,  ammonia).  In  the  center  of  this 
deck  are  the  carpenter's  and  plumber's  shop  and  a  steam 
laundry  of  ample  dimensions.  Forward  aft  on  this  deck  is 
ward  No.  5  with  forty  beds,  mess  room  and  quarters  for  the 
hospital  corps.  A  small  laboratory  for  scientific  work  has 
been  fitted  up  with  many  of  the  modern  facilities  and  has  been 
placed  in  charge  of  Dr.  Gray  of  the  Army  Medical  Museum. 
If  Santiago  has  not  been  taken  by  the  time  we  arrive  the  ship 
will  be  anchored  at  the  most  convenient  point  near  the  shore 
and  the  transfer  of  patients  will  be  made  by  the  use  of  the  two 
steam  launches  on  board.  Arrangements  have  been  made  for 
taking  patients  aboard  by  canvas  basket,  by  hoisting  boat,  or 


54 


by  stretcher  up  the  stair  gang,  which  for  this  purpose  has  been 
made  much  wider  than  usual.  The  ship  is  in  charge  of  Capt. 
Frank  Harding,  First  Officer  C.  W,  Crocker,  Second  Officer 
Harksen,  Engineer  Charlton  and  a  crew  of  sixty-eight  men. 
Major  Tomey  is  assisted  by  Major  W.  C.  Gourgas  and  Major 
Bradley,  both  of  the  United  States  Army.  Lieut.  J.  T.  Crabbs, 
8th  U.  S.  Cavalry,  is  quartermaster  and  commissary,  and  Rev. 
George  Robinson,  U.  S.  A.,  and  Rev.  Father  J.  N.  Connolly  of 
New  York,  are  the  chaplains.  Thre  are  sixteen  trained  nurses 
on  board,  ten  male  and  six  female,  and  a  detachment  of  twenty- 
nine  hospital  corps  men.  The  names  of  the  female  nurses  are  : 
Miss  Elise  H.  Lampe,  Miss  Louise  Jones  Block,  Miss  Amy 
B.  Furguhasson,  Miss  Lucy  Ashby  Sharp,  Miss  Amanda  J. 
Armistead,  Miss  Esther  Voorhes  Hasson.  The  following  con- 
tract surgeons  have  been  assigned  to  duty  on  the  ship:  Drs. 
Myers,  Schultz,  Tierney,  Jr.,  Williamson,  Hartlock  and  Met- 
calf.  The  ship  carries  a  large  supply  which  will  meet  the 
immediate  demands  of  the  sufifering  troops.  Every  one  on 
board  is  anxious  to  reach  the  destination  to  lend  a  helping 
hand.  Th3  female  nurses  have  utilized  the  time  in  preparing 
the  wards  for  the  reception  of  patients.  If  it  were  not  for  the 
blue  ocean,  the  waves  and  the  motion  of  the  ship,  it  would  be 
difficult  to  realize  that  we  are  not  in  a  well-regulated,  well- 
equipped  hospital  on  terra  firma  instead  of  a  floating  hospital. 
Tomorrow  (July  7)  the  doors  of  this  great  floating  institution 
will  be  thrown  open  for  the  benefit  of  those  who  have  become 
incapacitated  for  duty  in  the  field,  and  there  is  a  great  proba- 
bility that  every  cot  will  be  occupied  in  less  than  twenty-four 
hours  after  its  arrival  at  the  seat  of  action.  The  journey  so 
far  (July  6,  10  a.m.,  oS  San  Salvador)  has  been  a  very  pleasant 
and  auspicious  one.  A  stiff  breeze  from  the  south  is  fanning 
every  room  and  cheering  and  invigorating  its  inmates.  All  is 
in  readiness  to  fulfill  the  mission  for  which  this  messenger  of 
mercy  has  been  sent  to  the  distant  seat  of  war.  Thousands  of 
anxious  hearts  at  home  and  in  (>uba  are  following  its  course  in 
thought  and  prayer  and  will  be  rejoiced  when  they  know  that 
its  anchor  has  been  dropped  and  its  deck  cleared  for  action. 


THE  MEDICAL  DEPARTMENT  OF  THE  ARMY  IN  THE 
CUBAN  CAMPAIGN. 

On  Board  the  Hospital  Ship  "Relief,"  July  31,  1898. 
In  an  editorial  of  the  Medical  Record  of  July  30,  suspicions 
are  thrown  out  reflecting  on  the  efficiency,  foresight  and  proper 
management  of  the  Medical  Department  of  the  Army  during 
the  Cuban  Campaign.  The  remarks  made  by  the  editor  are 
based,  as  he  himself  asserts,  almost  exclusively  on  a  correspond- 
ence which  appeared  in  a  recent  issue  of  the  Sun.  In  com- 
menting on  this  article  the  editorial  states  :  "If  the  report  is 
true,  and  there  seems  to  be  no  good  reason  for  doubting  it,  the 
Army  Medical  Department  appears  in  a  very  unenviable  light. 
It  is  said  that  there  was  a  total  lack  of  everything  necessary 
for  the  proper  care  of  the  stricken  soldiers.  Why  this  was  so 
it  is  hard  to  explain,  especially  in  view  of  the  fact  that  the  war 
department  has  constantly  declared,  in  declining  voluntary 
assistance  from  charitable  organizations,  that  it  was  abund- 
antly able  to  cope  with  any  possible  emergency  in  the  field, 
and  yet  this  is  the  result."  The  correspondent  of  the  Sun 
made  bold  in  saying:  "It  was  evident  that  the  Medical 
Department  of  the  Army  had  failed  absolutely  to  send  hospital 
supplies,  or  by  this  time  they  would  have  been  landed.  On 
the  one  hand  it  was  pitiful.  On  the  other,  it  was  negligence 
that  could  have  been  the  result  only  of  incompetence."  I  am 
sure  if  the  editor  of  the  Medical  Record  had  been  better 
informed  he  would  not  have  been  so  willing  to  lend  his  ear  to  a 
newspaper  correspondent  whose  success  nowadays  consists 
largely  in  tinging  facts  with  more  or  less  imagination  and  sen- 
sationalism. The  medical  men  inside  and  outside  the  army 
have  little,  if  any,  influence  over  the  lay  press,  but  the  editor  of 
a  medical  journal  of  such  high  standing  with  the  medical  pro- 
fession throughout  the  entire  country  as  has  been  willingly 
accorded  the  Medical  Record,  should  take  the  necessary  pains 
to  investigate  more  thoroughly  the  circumstances  which  dic- 
tated the  editorial  before  casting  any  reflections  whatsoever  on 


56 


the  chief  of  the  medical  department.  Dr.  George  M.  Stern- 
berg is  no  stranger  to  the  medical  profession  and  the  American 
people.  He  occupies  the  exalted  position  of  Surgeon  General 
of  the  United  States  Army,  not  by  political  preferment  or 
gradual  ascent  by  promotion,  but  by  merit.  President  Cleve- 
land made  a  wise  selection  when  he  made  the  appointment. 
It  was  a  selection  that  met  with  the  heartiest  approval  on  all 
sides.  General  Sternberg  knows  from  long  and  actual  experi- 
ence what  it  is  to  be  a  soldier  in  the  field.  He  has  been  there. 
He  served  with  distinction  during  the  War  of  the  Rebellion. 
He  has  followed  the  unruly  and  wily  Indians  over  plains  and 
mountains  during  many  a  campaign.  He  has  investigated 
yellow  fever  at  home  and  abroad,  regardless  of  his  own  health 
and  life.  Since  he  has  been  placed  in  charge  of  the  Medical 
Department  of  the  Army  he  has  been  tireless  in  making  many 
much-needed  improvements. 

The  Army  Medical  School  is  one  of  the  many  fruits  of  his 
labors.  He  has  taken  special  interest  and  pride  in  promoting 
the  intellectual  and  professional  advancement  of  his  young 
army  surgeons,  assigning  them  for  temporary  duty  in  large 
cities,  where  they  could  enjoy  clinical  instruction  and  labora- 
tory work.  He  has  taken  a  deep  and  active  interest  in  the 
organization  and  usefulness  of  the  Association  of  Military 
Surgeons  of  the  United  States,  and  served  most  acceptably  as 
president.  Last  year  he  was  honored  by  the  profession  by 
election  to  the  Presidency  of  the  American  Medical  Associa- 
tion. The  earnest  devotion  to  his  duties  made  it  impossible 
for  him,  to  his  great  regret,  to  attend  the  Denver  meeting. 
The  name  of  General  Sternberg  is  often  seen  on  the  programs 
of  scientific  societies  from  the  Atlantic  to  the  Pacific  and  from 
Labrador  to  the  Gulf.  He  crossed  the  Atlantic,  last  summer, 
to  represent  his  Government  at  the  International  Congress, 
held  in  Moscow,  Russia,  and  his  work  there  added  much  to 
the  luster  of  American  medicine.  The  Surgeon-General,  now 
so  unjustly  accused  of  incompetency,  not  only  is  accorded  a 
well-deserved  place  in  the  front  rank  of  the  profession,  but 
his  administration  shows  executive  talents  which  have  served 
him  well  during  the  present  campaign.  He  has  shown  good 
judgment  in  the  selection  of  his  advisers.  Colonels  Alden, 
Greenleaf  and   Smart,  are  all  men  of   large  experience  and 


57 


admirable  executive  abilities,  as  all  can  testify  who  have  been 
brought  in  contact  with  them.  The  charge  of  incompetence 
and  ignorance  certainly  lacks  foundation  in  the  case  of  General 
Sternberg  and  his  administration.  Now,  as  to  facts.  The 
correspondent  of  the  Sun  who  furnished  all  the  material  for 
the  editorial  referred  to  goes  on  to  say  :  "  The  wounded  were 
carried  back  from  the  fighting  line  on  stretchers,  and  laid  on 
the  ground  to  wait  until  the  surgeons  could  reach  them.  Many 


Brigadier-General  George  M.  Sternberg,"  Surgeon-Gem^ral  of  the  Army. 

were  soon  beyond  the  need  of  surgical  treatment.  There  were 
four  divisions  of  the  army,  and  each  division  was  supposed  to 
have  its  hospital ;  but  as  a  matter  of  fact  there  was  but  one, 
the  division  hospital  of  the  Fifth  Army  Corps,  under  Major 
Wood.  There  were  five  surgeons,  a  hospital  steward,  and 
twenty  assistants,  to  care  for  the  wounded— several  hundred. 
They  had  a  number  of   operating  tables,  a  small  supply  of 


58 


medicines,  but  few  bandages,  and  no  food  for  sick  or  wounded 
men.  It  was  comparatively  easy  to  get  supplies  from  the  State 
of  Texas  ashore  to  the  hospital  here  (Siboneyj,  but  there  was 
no  transportation  to  the  front."  In  the  opinion  of  the  editor 
of  the  Medical  Record  and  the  correspondent  of  the  Sun  the 
Red  Cross  Association's  work  was  the  only  redeeming  feature 
of  the  whole  campaign,  to  judge  from  the  language  of  the 
latter  :  "God  knows  what  we  should  have  done  here  without 
the  help  of  the  Red  Cross— your  ship,  your  surgeons,  and 
your  nurses  I  and  there  is  no  other  help  for  us  at  the  front. 
Our  wounded  up  there  must  have  food,  bandages,  anything 
you  can  let  us  have  in  the  line  of  hospital  supplies."  The  edi- 
torial in  the  Medical  Record  brings  matters  to  a  focus  in  the 
closing  extract :  "  It  is  right  and  proper  that  the  Surgeon- 
General  should  resent  any  interference  with  his  prerogatives, 
but  he  should  not  directly  invite  it  by  making  possible  such 
a  condition  of  affairs  as  here  described."  This  inference  is 
entirely  unwarranted  by  facts  as  they  existed  during  and  after 
the  battle  of  Santiago. 

The  correspondent  and  editorial  do  not  even  mention  the 
steamer  Olivette  we  found  July  7  anchored  close  to  the  shore 
before  Siboney.  This  steamer,  in  command  of  Major  Appel, 
U.  S.  A.,  was  used  as  a  hospital  ship.  This  ship  was  in  place 
and  ready  to  receive  the  wounded  during  the  battle.  The 
steamer,  at  the  time  mentioned,  had  on  board  300  wounded, 
who  received  the  best  surgical  attention  and  nursing.  The 
next  day  the  steamer  left  for  the  United  States,  the  medical 
staff  being  reinforced  by  the  addition  of  Acting  Assistant- 
Surgeon  Brown  of  Chicago  from  the  Relief.  General  Stern- 
berg at  an  early  date  recognized  the  importance  of  hospital 
ships  during  this  war.  The  Olivette  was  chartered  for  this 
special  purpose,  Tas  well  equipped  and  reached  the  seat  of 
war  in  time.  The  hospital  ship  Relief,  formerly  the  John 
Englis,  under  the  supervision  of  its  commander.  Major 
Torrey,  was  transformed  into  an  ideal  floating  hospital  in  less 
than  six  weeks  and  reached  Siboney  July  7,  a  day  before  the 
Olivette  left  for  its  home  port.  Do  these  things  show  either 
negligence  or  ignorance  ?  Do  they  not  rather  demonstrate 
foresight  and  an  earnest  endeavor  to  better  care  for  the  sick 
and  wounded  in  a  w^ay  creditable  to  our  country  and  the  chief 


59 


of  the  Medical  Department?  This  question  can  safely  be  left  for 
the  wounded  to  answer.  The  Surgeon-General  accepted  the 
legitimate  services  of  the  Red  Cross  Association  and  had  rea- 
son to  expect  aid  from  this  source,  should  pressing  emergen- 
cies present  themselves.  The  medical  officers,  the  wounded 
and  the  sick  have  every  reason  to  be  grateful  to  Miss  Clara 
Barton,  for  what  she  did  in  furnishing  ice,  delicacies  and 
medical  supplies.  The  State  of  Texas  did  excellent  work  in 
aiding  the  Medical  Department,  but  that  is  no  reason  why 
those  connected  with  the  Red  Cross  Association  should  claim 
all  the  credit  and  undertake  to  criticise  a  department  of  the 
government  which  has  done  all  it  possibly  could  in  anticipating 
the  requirements  of  a  sudden  emergency.  It  is  a  source  of 
great  regret  that  there  should  be  any  friction  whatever 
between  the  Medical  Department  and  the  friends  and  sup- 
porters of  the  Red  Cross  Association.  It  must  be  clear  to 
every  unprejudiced  mind  that  the  treatment  of  the  sick  and 
wounded  must  remain  under  the  direct  care,  control  and  man- 
agement of  the  Medical  Department,  and  that  the  function  of 
Red  Cross  is  rather  auxiliary  to  it  than  as  an  independent 
organization  if  the  greatest  amount  of  good  is  to  be  realized 
from  it.  The  hospital  ship  Relief  brought  an  immense  amount 
of  medical  supplies,  delicacies,  cots,  pillows  and  blankets. 
When  we  arrived  at  Siboney  we  knew  our  presence  was  much 
needed,  and  looked  in  vain  for  some  one  to  inform  us  where  and 
how  to  land.  The  precipitous  and  rocky  nature  of  the  shore 
and  the  great  depth  of  the  ocean  made  it  unfavorable  to  secure 
anchorage  for  several  days.  A  single  lighter  attended  to  the 
demands  of  numerous  transport  ships.  I  am  sure  no  one 
could  blame  the  Medical  Department  for  the  unavoidable 
delay  in  unloading  the  supplies.  The  little  steam  launches  did 
what  could  be  done  in  bringing  to  the  shore  what  was  most 
needed.  Major  Torrey  worked  night  and  day  in  supplying 
the  requisitions  made  by  the  surgeons  in  the  field  and  hospi- 
tals. There  was  no  red  tape  here,  all  they  had  to  do  was  to 
inform  him  what  was  wanted  and  it  w^as  delivered  as  soon  as 
it  could  be  brought  to  the  shore.  The  lack  of  proper  transpor- 
tation facilities  from  the  landing  to  the  front  can  not  be 
charged  to  the  Medical  Department.  It  took  more  than  a 
week  of  the  hardest  kind  of  work  to  land  all  of  the  supplies, 


60 


and,  considering  the  limited  facilities  available,  it  is  and 
always  must  be  regarded  as  a  source  of  satisfaction  that  it  was 
made  possible  at  all.  The  Relief  brought  1000  cots  and  an 
ample  supply  of  bankets,  which  reached  the  hospitals  with  as 
little  delay  as  possible. 

Lieut.  Crabbs  of  the  8th  Cavalry,  showed  a  creditable  degree 
of  ingenuity,  energy  and  often  of  courage  in  landing  the  sup- 
plies. The  complaint  that  the  sick  and  wounded  lacked  medi- 
cines and  dressing  materials  is  true  only  to  a  certain  extent. 
Some  of  the  medicines  were  exhausted,  owing  to  the  unexpected 
enormous  demand,  but  they  were  supplied  as  quickly  as  could 
be  done  under  the  existing  circumstances.  The  writer  had  the 
privilege  to  operate  in  all  of  the  hospitals  and  was  always  able 
to  find  the  essential  antiseptics  and  dressing  materials  required 
in  military  practice,  and  this  was  at  a  time  when  the  supplies 
were  at  the  lowest.  There  was  no  lack  at  any  time  of  stimu- 
lants and  anesthetics.  There  is  no  use  in  denying  the  fact 
that  immediately  after  the  battle  the  tentage  and  blanket  sup- 
ply were  inadequate,  but  these  defects  were  corrected  promptly. 
War  always  has  had  its  hardships  and  discomforts  ;  it  can  not 
be  prosecuted  in  parlor  cars  and  clubhouses.  Or  soldiers  ex- 
pected deprivations  and  unavoidable  discomforts,  but  on  the 
whole  they  were  subjected  to  less  actual  suffering  than  they 
had  reason  to  look  for.  To  the  credit  of  the  medical  oflBcers  it 
must  be  said  they  shared  the  inevitable  hardships  with  the 
soldiers.  They  lived  on  the  same  food,  drank  the  same  water 
and  made  the  moist  ground  their  beds.  The  writer  will  always 
cherish  the  memory  of  the  hardships  incident  to  a  campaign 
in  a  foreign  country,  a  tropical  climate  and  among  a  strange 
people.  The  Cuban  campaign  was  planned  and  executed  so 
quickly  that  some  omissions  and  defects  had  to  be  expected. 
It  is  a  source  of  gratification  to  know  that  the  complaints 
made  against  the  medical  department  have  come  from  news- 
paper correspondents  and  camp  followers  more  than  from  the 
soldiers  themselves.  Among  the  thousands  of  sick  and  wounded 
with  whom  I  have  been  brought  in  contact  during  the  Cuban 
campaign  I  have  seldom  heard  a  complaint :  on  the  contrary, 
I  have  heard  nothing  but  words  of  praise  for  the  hard-working, 
self-sacrificing  medical  officers  and  the  department  they  repre- 
sent in  the  field. 


THE    QUALIFICATIONS    AND     DUTIES    OF 
THE   MILITARY   SURGEON. 


Nearly  five  months  of  continuous  service  with  the 
army  in  the  camp  and  field  has  afforded  me  an  excel- 
lent opportunity  to  make  a  practical  study  of  the 
above  subject.  This  time  was  spent  in  Camp  Tanner, 
Springfield,  111.;  Camp  George  H.  Thomas,  Chicka- 
mauga,  Ga.,  and  the  Cuban  campaign,  the  time  being 
about  equally  divided  in  the  different  places.  The 
first  four  weeks  were  occupied  in  Camp  Tanner, 
where  I  assisted  in  the  capacity  of  Surgeon- General 
of  the  State  in  the  organization  of  the  State  troops. 
This  service  brought  me  into  closer  contact  with  the 
National  Guard  of  our  State  than  at  any  time  before. 
A  physical  and  professional  examination  in  which  I 
took  part  brought  out  the  shady  as  well  as  the  sunny 
side  of  their  qualifications.  The  result  of  my  experi- 
ence here  convinced  me  that  the  average  National 
Guard  surgeon  is  a  faithful  doctor,  with  more  than 
average  professional  ability,  but,  with  few  exceptions, 
lacking  the  necessary  military  training  in  performing 
satisfactorily  his  administrative  duties.  This  is  a 
part  of  his  education  that  has  been  sadly  neglected 
in  the  past  and  should  receive  more  attention  in  the 
future.  Very  few  States  make  provision  for  physi- 
cal examination  of  the  medical  officers,  consequently 
some  of  them  have  entered  the  service  totally  dis- 
qualified for  participating  in  an  active  campaign. 
Two  of  the  candidates  for  the  volunteer  service  from 
the  National  Guard  of  Illinois  were  rejected  on  this 
ground.  The  four  weeks'  service  at  Camp  George 
H.  Thomas  as  chief  surgeon  of  the  Sixth  Army 
Corps  opened  up  a  wide  field  for  extended  observa- 
tions in  making  comparisons  between  the  work  done 


(32 

by  the  surgeons  of  the  regular  army  and  of  the 
National  Guard.  The  surgeons  of  the  United  States 
Army  are  all  men  of  superior  education,  splendid 
physical  development,  and  those  who  have  been  in 
the  service  for  several  years  are  well  versed  in  the 
routine  work  of  the  Medical  Department.  However, 
in  all  matters  pertaining  to  medicine  and  surgery 
the  average  National  Guard  surgeon  more  than  holds 
his  own.  This  superiority  of  the  National  Guard 
surgeon  over  his  colleague  of  the  regular  army  is 
no  reflection  on  the  latter;  it  is  the  natural  outcome 
of  circumstances,  which  made  such  a  difference  inev- 
itable. The  young  army  surgeon  has  to  spend  many 
years  at  small  and  often  out-of-the-way  posts,  where  the 
opportunities  for  clinical  experience  and  intercourse 
with  professional  colleagues  are  necessarily  limited. 
He  naturally  soon  falls  into  the  monotonous  and 
routine  work  of  the  post  life,  with  little  or  no  induce- 
ments to  continue  his  post-graduate,  scientific  and 
medical  studies.  When  the  time  comes  to  pass  an 
examination  he  wakes  uj)  from  his  lethargy  suffi- 
ciently to  go  through  the  different  compends  to  pre- 
pare himself  for  the  coming  ordeal.  He  breathes 
easy  after  he  has  reached  the  major's  rank,  as  this 
promotion  forever  closes  the-  door  of  the  much- 
dreaded  green  room.  From  now  on  he  is  in  the 
line  of  slow  promotion  without  any  extra  exertions 
on  his  part.  He  receives  his  salary  and  looks  confi- 
dently for  assignments  to  posts  where  he  can  spend 
the  balance  of  his  life  in  ease  and  luxury.  He  has 
reached  a  time  in  life  when  he  feels  that  he  can  avail 
himself  of  the  work  of  his  subordinates  without 
interfering  with  his  emoluments  or  his  position  in 
social  and  military  life.  He  is  conscious  of  the  fact 
that  he  has  reached  a  rank  and  a  station  in  life  where 
it  is  i^roper  for  him  to  look  to  his  assistants  to  do  the 
drudgery  which  he  had  become  accustomed  to  in  the 
past,  and  begin  to  enjoy  the  life  before  him.  It  is 
different  with  the  military  surgeon  taken  from  civil 
life.     He  emerges  from  the  turmoils  of  family  prac- 


63 

tice.  From  the  day  of  his  graduation  he  has  tasted 
the  bitter  fruit  of  active  competition.  His  work  has 
been  watched  with  an  envious  eye  and  subjected  to 
sharp  criticism  by  his  neighboring  colleagues,  old  and 
young.  He  felt  from  the  very  beginning  of  his  pro- 
fessional career  that  success  depended  upon  his  own 
exertions.  The  average  American  practitioner  is  a 
hustler.  He  is  willing  to  work  night  and  day  to  gain 
a  lucrative  practice  and  the  social  position  which  goes 
with  it.  With  few  exceptions  he  knows  that  what  he 
has  learned  in  college  is  but  the  entering  wedge  to  a 
comprehensive  knowledge  of  the  practice  of  medicine 
and  surgery.  He  knows  that  our  profession  has 
become  a  progressive  one.  His  college  education 
tells  him  what  is  new  today  will  be  old  tomorrow. 
He  looks  with  pity  on  his  colleagues,  advanced  in 
years,  whose  language  and  practice  convince  him  that 
they  have  fallen  into  a  dangerous  rut.  He  reads  the 
numerous  medical  journals,  the  great  avenues  of 
recent  medical  literature.  He  spends  his  scanty 
income  in  purchasing  new  books  and  instruments  for 
scientific  investigations.  All  requisitions  are  made  on 
himself  and  are  honored  only  by  writing  bis  own 
checks.  He  joins  medical  societies,  large  and  small, 
and  attends  their  meetings  regularly.  He  listens 
intently  to  the  reading  of  papers  and  discussions  to 
increase  his  store  of  knowledge  and  returns  to  his 
limited  field  of  action  better  prepared  to  battle  against 
disease.  He  mingles  freely  with  the  members  of  his 
profession,  always  ready  to  absorb  and  digest  new 
ideas.  He  makes  frequent  pilgrimages  to  his  alma 
mater  or  some  post-graduate  school  to  familiarize 
himself  with  the  most  recent  advances  in  medicine  and 
surgery.  Social  life  has  no  attractions  for  him ;  he  has 
entered  the  profession  for  the  sole  purpose  of  becom- 
ing an  influential  and  successful  practitioner.  This 
is  the  kind  of  material  our  National  Guard  surgeon  is 
made  of.  No  wonder  he  outweighs  the  professional 
military  surgeon  in  practical  knowledge  required  in 
the  treatment  of  injuries  and  disease. 


64 

The  exacting  and  often  onerous  duties  of  the  mili- 
tary surgeon  in  times  of  war  require  special  qualifica- 
tions to  prepare  and  fit  him  for  his  work.  He  is  not 
only  expected  to  be  well  versed  in  theoretical  and 
practical  knowledge  of  everything  pertaining  to  the 
practice  of  medicine  and  surgery,  but  he  must  be 
endowed  with  qualities  both  of  mind  and  body  upon 
which  he  can  rely  when  engaged  under  the  most  try- 
ing circumstances.  In  field  work  he  has  often  to 
perform  the  most  difficult  tasks  with  very  limited 
resources.  In  such  instances  good  common  sense 
and  deliberate  action  go  much  further  in  accomplish- 
ing what  is  desired  than  the  finest  scholarship  and 
the  most  profound  logical  reasoning.  The  man  who 
can  in  a  few  moments  extemporize  a  well-fitting  splint 
out  of  the  simplest  materials  and  perform  with  the 
contents  of  an  ordinary  pocket  case  the  most  difficult 
operation  will  do  vastly  better  work  on  the  battlefield 
than  most  professors  of  surgery  and  the  most  brilliant 
operators  in  civil  practice.  The  surgeon  who  under- 
stands the  principles  and  practice  of  good  cooking  is 
of  more  service  to  the  troops  than  the  one  who  can 
repeat,  word  for  word,  the  contents  of  the  most 
exhaustive  treatise  on  materia  medica  and  therapeu- 
tics. The  medical  officer  with  a  full  knowledge  of 
hygiene  and  sanitation  and  endowed  with  the  faculty 
of  making  a  rational,  practical  use  of  it  is  preferable 
to  the  most  expert  clinician,  as  in  military  practice  it 
is  more  important  to  prevent  than  to  treat  disease,  no 
matter  how  successfully  and  scientifically  the  latter 
may  be  conducted.  The  all-around  medical  officer 
must  be  a  good  mechanic;  he  should  know  how  to  use 
the  carpenter's  and  blacksmith's  tools,  how  to  row  and 
sail  a  boat,  how  to  make  a  raft  and  occasionally  he 
will  have  reason  to  be  thankful  if  he  has  learned  how 
to  pack  a  mule  and  drive  an  ambulance  team.  His 
miscellaneous  knowledge  of  matters  and  things  en- 
tirely outside  of  his  legitimate  province  will  be  con- 
stantly drawn  upon  from  difPerent  sources  and  the 
more  he  knows  and  is  willing  to  impart'  the  more  he 


65 


will  be  useful  and  popular.  The  man  who  enters  the 
medical  dei3artment  of  the  army  under  an  impression 
that  he  is  only  expected  to  treat  wounds,  set  broken 
bones  and  prescribe  for  the  ordinary  camp  ailments 
makes  a  serious  mistake  and  will  be  surely  a  disap- 
pointment both  to  himself  and  to  those  he  is  expected 
to  serve. 

Physical  condition. — The  ideal  military  surgeon  in 
possession  of  the  necessary  mental  and  physical  qual- 


Transfer  of  wounded  to  the  hospital  ship  Relief  at  Arroya. 

ities  to  make  him  so  is  seldom  seen.  The  most  active 
brains  are  often  found  in  a  frail  body.  I  have  often 
seen  in  civil  life  surgeons  of  great  reputation  strug- 
gling with  disease  or  its  effects,  or  the  victims  of 
some  congenital  or  acquired  defects,  who  were  won- 
ders in  the  operating  amphitheatre  in  spite  of  such 
disability.  I  have  seen  more  than  once  the  saddest 
of  all  spectacles  in  professional  life — a  surgeon,  himself 
the  subject  of  an  incurable  disease,  muster  into  service 
every  particle  of  his  reserve  strength  to  perform  a 


66 

critical  operation  with  a  view  of  saving  the  life  of 
another.  Achievements  of  this  kind  are  possible  in 
private  practice  but  are  entirely  out  of  the  question 
in  military  service.  The  physical  condition  of  the 
military  surgeon  must  be  as  nearly  perfect  as  possible. 
A  physical  examination  as  thorough  and  as  painstak- 
ing as  in  the  case  of  a  private  can  only  decide  upon 
the  necessary  physical  qualifications  of  candidates  for 
commission  in  the  medical  service.  For  good  reasons 
this  rule  is  followed  in  the  selection  of  medical  offi- 
cers for  the  regular  army  and  there  is  no  ground  why 
the  same  requirement  should  not  be  exacted  in  the 
National  Guard.  During  my  service  at  Chickamauga 
and  in  the  Cuban  campaign,  I  saw  more  than  one 
volunteer  surgeon  who  ought  to  have  been  excluded 
from  the  service  for  physical  disability.  During  a 
campaign  the  loss  of  a  single  medical  officer  may 
prove  a  great  disaster.  Of  all  commissioned  officers 
the  surgeon  is  the  most  indispensable.  The  vacant 
place  of  a  line  officer  can  be  filled  at  a  moment's 
notice  without  any  serious  loss  to  the  service:  not  so 
with  the  surgeon.  His  position  is  one  requiring 
special  training  and  one  that  can  not  be  filled  without 
crippling  the  medical  service  at  some  other  point.  For 
this,  if  for  no  other  reason,  the  medical  officer  must 
be  in  sound  health  and  able  to  cope  successfully  with 
the  hardships  of  a  campaign.  In  battle,  and  during 
the  prevalence  of  an  endemic  or  epidemic  disease,  the 
medical  officer  is  the  one  above  all  others  whose 
strength  and  endurance  are  taxed  to  their  utmost 
extent.  His  services  are  required  by  day  and  by 
night.  He  has  no  rest,  and  unless  in  i)ossession  of 
an  iron  constitution,  his  strength  fails  him  and  he 
becomes,  if  not  a  fit  subject  for  the  hospital,  at  least 
a  physical  wreck,  who,  if  he  persists  in  continuing  his 
work,  will  often  do  more  harm  than  good.  A  number 
of  such  instances  came  to  my  personal  notice  during 
the  Cuban  campaign.  A  medical  officer  should  not 
only  be  in  full  possession  of  health  and  all  that  this 
implies,   but   he   should    have   been   in   training   to 


67 


endure  hardships  of  all  kinds  from  early  childhood. 
He  need  not  necessarily  be  an  athlete,  but  he  should 
be  able  to  walk  twenty  miles  a  day  or  ride  forty  with- 
out fatigue  and  then  be  ready  to  do  a  night's  work 
should  an  emergency  demand  it.  The  dancing  halls 
and  club  houses  are  poor  training  schools  for  a  suc- 
cessful military  career.  The  lal^or  and  hardships 
encountered  in  hunting  are  best  calculated  to  prepare 
the  body  for   a  life  of  great  activity  and  privation. 


The  Spanish  military  hospital  in  Ponce,  Porto  Rico. 

Frugal  living  will  not  only  prove  conducive  to  the 
maintenance  of  health  but  will  be  the  best  means  of 
initiating  the  surgeon  to  the  uncertainties  of  the  com- 
missary department  when  on  the  march  or  in  the 
field. 

Let  every  one  who  chooses  the  military  career  dis- 
pense with  unnecessary  clothing  and  luxuries  during 
early  life  in  order  to  accustom  and  adapt  himself  for 
his  life  work,  which  in  time  of  war  will  bring  the 
inevitable  amount  of  viscissitudes  and  even  suffering. 


G8 

The  medical  officer  must  be  a  good  horseman,  which 
here  not  only  implies  a  good  rider,  but  a  knowledge 
of  the  usual  ailments  of  horses,  the  treatment,  feed- 
ing and  care  of  the  animals.  To  sum  up,  the  military 
surgeon  must  be  a  man  of  vigor,  made  so  by  birth  and 
training,  with  as  few  requirements  in  his  habits  of 
living  as  possible,  in  order  that  he  may  resist  to  the 
highest  degree  the  influences  of  climate  and  disease 
and  prepare  himself  for  the  hardships  and  privations 
incident  to  active  warfare. 

Mental  qiLalifications.  —  A  proper  and  adequate 
preliminary  education  is  exacted  of  every  surgeon  in 
the  regular  army;  without  it  he  is  not  permitted  to 
pass  the  medical  examination.  Statistics  show  that 
a  large  percentage  of  the  candidates  are  dropped  at 
this  stage  of  the  examination.  This  is  a  reflection 
on  the  system  of  medical  education  which  continues 
to  prevail  in  our  country.  About  the  only  evidence 
of  proficiency  the  National  Guard  surgeon  in  most  of 
our  States  is  required  to  show  is  his  diploma.  It 
makes  but  little  difference  when  the  diploma  was 
obtained.  Evidences  of  a  satisfactory  preliminary 
education  are  not  required.  In  consequence  of  such 
an  easy  entrance  into  the  medical  service  of  our  State 
troops,  many  of  the  men  who  receive  commissions 
are  illiterate.  By  hard  post-graduate  work  they  often 
become  good  physicians,  but  they  seldom  if  ever 
make  up  for  the  early  defects  of  their  education, 
which  seriously  interfere  with  a  successful  military 
career.  Is  it  to  be  wondered  at  that  when  such  short- 
comings are  discovered  by  their  colleagues  and  officers 
of  the  line,  they  do  not  command  the  respect  their 
commissions,  should  entitle  them  to?  The  reports 
made  out  by  such  men  speak  for  themselves,  and 
appear  as  black  stains  upon  the  department  they  rep- 
resent. The  elevation  of  the  standard  of  medical 
education  by  most  of  the  medical  schools  throughout 
the  country  will  gradually  wipe  out  this  blemish,  but 
it  will  take  many  years  before  all  of  the  diplomas  can 
be  accepted  as  sufficient  proof  that  their  possessors 


69 


are  entitled  to  recognition  by  the  medical  department 
of  the  different  States.  Let  us  hope  that  a  speedy 
and  radical  reform  may  be  instituted  in  the  different 
States  ?7hich  will  accomplish  the  desired  object,  and 
which  will  make  the  commission  of  a  medical  officer 
of  greater  import  in  showing  a  higher  degree  of  pre- 
liminary and  professional  proficiency  than  the  diploma 
of  any  of  our  medical  colleges.  This  is  a  desideratum 
for  the  realization  of  which   every  one  interested  in 


Ambulance  train  on  the  way  to  the  hospital  ship  Relief  in  the  harbor 
of  Ponce. 

the  success  and  usefulness  of  the  national  guard 
should  willingly  use  his  influence.  Fortunately,  there 
are  no  specialties  in  military  practice.  The  medical 
education  of  a  military  surgeon  must  be  of  the  most 
liberal  and  broadest  kind.  His  practice  is  so  varied 
that  he  may  have  to  be  physician,  surgeon,  oculist, 
aurist,  etc.,  the  same  day.  The  sphere  of  the  regular 
army  surgeon  serving  at  a  post  includes  in  addition 
obstetrics,  gynecology  and  diseases  of  children.  Every 


70 

military  surgeon  must  be  an  expert  in  physical  diag- 
nosis and  examination  of  the  eye  and  ear.  He  must 
know  something  about  dentistry,  he  must  know  how 
to  extract  teeth  and  how  to  put  in  a  temporary  filling 
in  a  carious  tooth  that  can  be  saved.  He  must  be 
familiar  with  neurology,  the  use  and  application  of 
electricity  as  a  diagnostic  and  therapeutic  resource. 
In  camp  and  field  he  is  limited  to  his  own  resources 
in  the  diagnosis  and  treatment  of  all  kinds  of  injuries 
and  diseases.  He  must  therefore  be  well  equipped 
with  a  thorough  knowledge  of  everything  pertaining 
to  surgery  and  medicine,  and  is  often  called  upon  to 
represent  the  different  specialties.  No  amount  of 
preliminary  and  professional  education  will  make  the 
military  surgeon  an  efficient  officer  unless  he  is  pos- 
sessed of  an  inborn  aptitude  for  the  profession.  He 
must  be  able  to  apply  and  make  use  of  his  knowledge. 
Many  men  of  great  learning  never  become  successful 
practitioners.  Their  store  of  knowledge  fails  them 
when  they  come  to  apply  it,  The  military  surgeon 
in  camp  and  field  must  be  a  man  of  quick  perception. 
He  must  be  able  to  recognize  malingering  as  well  as 
disease.  In  an  emergency  he  must  be  in  readiness  to 
act  intelligently  at  a  moment's  notice.  Hesitation  is 
dangerous  both  to  the  patient  and  the  reputation  and 
good  standing  of  the  surgeon.  Indecision  creates 
mistrust,  procrastination  disaster.  Quick  decision 
and  prompt  action  are  the  essential  prerequisites  of 
successful  emergency  work.  Successful  action,  how- 
ever, must  be  preceded  by  thoughtful,  systematic 
preparation.  The  most  successful  surgeon  is  the  one 
who  adopts  and  follows  the  watchword,  semper  para- 
tus.  He  should  never  be  caught  napping.  Careful 
preparation  makes  prompt  action  possible.  The  suc- 
cessful surgeon  makes  his  plans  ahead  and  supplies 
himself  with  the  necessary  outfit,  medicine,  dressing 
materials  and  instruments  before  the  emergency  arises, 
and  when  it  does  so  he  is  fully  prepared  to  meet  it. 
A  lack  of  forethought  and  systematic  preparation 
accounts  for  many  shortcomings  of  medical  officers 


71 


in  the  field  and  camp,  with  the  necessary  evil  conse- 
quences for  those  entrusted  to  their  care. 

Military  spirit. — Any  one  who  enters  the  medical 
service  of  the  army  as  a  life  avocation  will  be  disap- 
pointed unless  he  does  so  imbued  with  a  proper  mili- 
tary spirit.  The  military  surgeon  must  be  a  military 
man  and  an  integral  part  of  the  army,  if  he  wants  to 
do  justice  to  his  calling  and  the  department  he  repre- 
sents.    I  fear  it  is  a  lack  of  the  proper  military  spirit 


Litter  work  in  the  court  of  the  Spanish  military  hospital  in  Ponce 

in  some  of  the  medical  officers  in  the  regular  army 
that  is  responsible  for  a  well  recognizable  cleft 
between  them  and  the  officers  of  the  line  and  field. 
If  this  is  true  in  the  regular  army,  it  is  only  too  obvi- 
ous in  the  National  Guard.  The  rank  of  the  medical 
officers  and  their  standing  in  military  and  social  cir- 
cles suffer  when  they  are  regarded  and  treated  as  an 
ordinary  doctor.  The  West  Point  graduate,  educated 
at  the  expense  of  the  government,  too  often  forgets 
that  it  takes  more  hard  work  and   a   longer  time  to 


72 

make  a  good  doctor  than  an  officer.  The  officers  of 
the  National  Guard,  holding  commission  by  the  grafce 
of  their  governor,  do  not  realize  sufficiently  that  their 
military  surgeons  have  spent  a  small  fortune  and  five 
years  in  acquiring  a  knowledge  of  their  i^rofession. 
They  seem  to  forget,  or  at  any  rate  often  ignore,  that 
when  they  go  into  camp  or  in  the  field  they  do  so  at 
a  great  personal  and  pecuniary  sacrifice.  Their  ab- 
sence from  home,  even  for  a  short  time,  may  cause  a 
break  in  their  practice  difficult  to  repair.  The  medi- 
cal officer  is  entitled  to  recognition  as  a  military  man, 
and  if  this  is  not  accorded  to  him  voluntarily,  he 
must  resort  to  measures  that  will  enforce  it.  The 
lack  of  military  dignity  on  part  of  the  medical  staff 
is  due  largely  to  a  lack  of  the  proper  military  spirit 
in  the  members  which  compose  it,  and  to  too  great  a 
familiarity  between  the  surgeons  and  the  officers  and 
men.  The  correction  of  these  evils  can  not  be  under- 
taken too  soon,  and  when  accomplished  will  add  much 
to  the  dignity,  influence  and  efficiency  of  the  medical 
department  of  the  army  and  State  troops. 

The  medical  officer  who  has  enjoyed  the  advantages 
of  an  early  military  training  in  a  military  academy 
or  the  national  guard,  is  the  one  best  qualified  to 
enforce  military  rules  and  assert  the  dignity  of  his 
position. 

Punctuality. — The  busiest  men  have  always  the 
most  time  to  perform  a  duty  or  to  meet  an  engage- 
ment at  the  appointed  time.  This  rule  holds  good  in 
all  walks  of  life.  The  drones  are  always  behind.  In 
military  life  punctuality  means  everything  and  from 
this  exaction  the  medical  officer  should  never  be 
excluded  except  for  special  and  well  founded  reasons. 
In  the  regular  army  there  is  a  way  of  disciplining  the 
medical  as  well  as  other  officers  in  coming  to  time  in 
the  performance  of  definite  duties  and  in  making  out 
the  reports.  My  long  experience  in  the  National 
Guard  service  has  taught  me,  occasionally  in  a  pain- 
ful way,  that  the  surgeons  are  often  entirely  oblivious 
to  the   matter  of  time,  especially  in    the   matter   of 


73 


making  out  and  transmitting  the  regimental  reports. 
It  is  the  men  who  put  off  for  tomorrow  what  should 
be  done  today,  and  who  meet  their  engagements  at 
one  o'clock  or  thereafter  instead  of  twelve,  that  ren- 
der the  life  of  their  superior  officers  one  of  misery 
and  full  of  disappointments.  The  men  that  accom- 
plish the  most  are  always  ready  and  on  time.  The 
medical  officers  must  be  made  to  understand  that  a 
due  regard  for  punctuality  in  performing  their  duties, 


Covirt  of  the  Spanish  military  hospital  in  Ponce. 

in  meeting  appointments  and  in  mapping  out  and 
forwarding  reports  is  one  of  the  most  essential  feat- 
ures of  a  successful  military  career. 

Courage. — It  is  still  the  general  belief  that,  in 
times  of  war  the  military  surgeon  is  exposed  to  less 
danger  than  the  soldiers  and  officers  in  command. 
That  this  is  not  so  is  shown  by  the  statistics  of  all 
wars.  Although  the  position  of  the  military  surgeon 
is  behind  the  fighting  line,  he  is  usually  near  enough 


74 

to  the  enemy  when  serving  in  the  front  to  be 
reached  by  stray  bullets  and  bursting  shells.  The 
number  of  surgeons  killed  and  wounded  in  the  per- 
formance of  their  duty  in  rendering  first  aid  is  by  no 
means  small  in  any  war  of  magnitude.  In  active  war- 
fare, however,  the  greatest  danger  to  the  surgeons  is 
to  be  found  in  their  constant  exposure  to  contagious 
and  infectious  diseases,  which  follow  large  armies  in 
all  climates  and  during  all  seasons  of  the  year.  To 
enter  a  yellow  fever  camp,  to  my  mind,  calls  for  more 
courage  than  to  lead  and  command  the  troops  in  the 
battlefield.  Disease  always  claims  more  victims  than 
bullets,  and  this  is  especially  true  of  the  present  war 
with  Spain.  The  nation  worships  the  heroism  of 
those  who  fell  before  Santiago,  but  much  less  is  said 
of  the  vastly  greater  number  stricken  down  by  dis- 
ease, and  who  have  lost  their  lives  from  disease,  often 
after  prolonged  and  intense  suffering.  To  the  credit 
of  the  medical  officers  of  this  and  other  wars  it  must 
be  said  that  they  showed  no  fear,  either  in  facing  the 
enemy  or  what  is  vastly  worse — disease.  When  yel- 
low fever  made  its  appearance  among  the  troops 
around  Santiago,  every  man  remained  at  his  post  and 
faced  the  danger  without  flinching.  Men  from  the 
North  who  had  never  seen  the  disease  accepted  the 
detail  for  duty  in  the  fever  hospitals  without  a  word 
of  complaint.  The  medical  officer  must  be  endowed 
with  more  than  ordinary  courage  to  face  the  many 
dangers  that  surround  him  on  all  sides  during  every 
campaign.  Patriotism  begets  heroism  and  I  make  a 
well-founded  claim  for  both  for  the  medical  profes- 
sion represented  in  the  army. 

Personal  habits. — The  old  adage  that  'Tt  is  easier 
to  preach  than  to  practice.''  is  a  familiar  one  and 
should  be  made  to  apply  with  the  same  force  to  doc- 
tors as  preachers.  The  first  and  most  important  duty 
of  the  military  surgeon  is  to  prevent  disease.  This 
can  often  be  done  more  effectively  by  example  than 
by  precept.  The  military  surgeon  must  guard  the 
camp  against  disease.     He  is  looked  upon  and  must 


75 


be  regarded  by  those  under  his  care  as  the  one  above 
all  others  who  can  give  them  advice  in  matters  per- 
taining to  their  health.  He  is  expected  to  do  this  by 
example  as  well  as  precept.  He  must  become  a  per- 
manent object  lesson  in  inculcating  the  importance 
of  cleanliness  in  person  and  in  dress.  His  tent 
should  be  the  cleanest  and  most  orderly  in  camp. 
Temperance  in  eating  and  drinking  can  be  taught 
more  successfully  by  action  than  by  words.     A  mili- 


Transfer  of  patients  to  the  lifeboat  in  the  liarbor  of  Ponce. 

tary  surgeon  under  the  influence  of  liquor  will  do 
more  harm  in  encouraging  the  vice  of  intemperance 
than  can  be  undone  by  weeks  of  lecturing.  Profan- 
ity is  prevalent  in  every  camp  and  while  it  is  not  the 
duty  of  the  surgeon  to  supplant  the  chaplain  in  sup- 
pressing it,  it  should  receive  no  encouragement  by 
his  example.  In  his  conduct  toward  the  men  the 
surgeon  should  be  firm  and  dignified,  yet  kind  and 
sympathetic,  especially  to  those  in  need  of  his  pro- 


7<^ 

fessional  services.  An  impetuous  nature  and  an  irri- 
table temper  create  a  rebellious  spirit,  which  it  is 
difficult  to  control  by  the  most  energetic  measures. 
Proper  questions  should  be  answered  willingly  and 
with  sufficient  clearness  and  adequate  length  to  fur- 
nish tlie  desired  information,  and  not  gruffly  and 
snappishly,  as  is  occasionally  done  without  any 
reason  or  provocation.  Overwork  and  a  disordered 
digestion  are  poor  excuses  for  treating  a  subordinate 
in  an  undignified,  ungentlemanly  manner.  The  mil- 
itary surgeon  must  be  known  in  camp  as  a  gentleman, 
not  only  by  the  officers  but  by  every  man  under  his 
charge,  if  he  expects  to  be  respected  and  to  do  justice 
to  his  high  calling  and  responsible  position. 

The  mUitarij  surgeon  in  war. — The  true  qualities 
of  the  military  surgeon  are  crystallized  and  best 
known  during  an  active  campaign.  It  is  in  war  that 
his  ready  resources  will  come  to  the  surface  and  will 
be  subjected  to  the  severest  tests.  It  is  in  battle  and 
during  the  prevalence  of  devastating  diseases  that  his 
moral  courage  and  physical  endurance  will  be  most 
severely  tried.  It  is  under  such  circumstances  that  the 
troops  will  look  to  him  most  confidently  as  their  protec- 
tor and  nearest  and  dearest  friend.  It  is  not  in  peace 
but  in  war  that  the  bond  of  true  comradeship  becomes 
tighter  and  tighter  between  him  and  the  officers  and 
men.  It  is  on  the  march,  in  camp,  and  on  the  battle- 
field that  the  important  function  of  the  military  sur- 
geon receives  the  recognition  to  which  it  is  entitled. 
It  is  the  wounded  and  the  sick  in  a  strange  land  that 
look  to  him  for  help  and  restoration  to  health.  It  is 
the  surgeon  who  so  often  receives  the  last  message  of 
the  dying. 

The  first  and  most  important  duty  of  the  military 
sur^^eon  during  active  warfare  is  to  prevent  disease 
and  unnecessary  suffering  by  giving  early  advice  and 
resorting  to  timely  precautions.  The  location  of 
camps,  policing  of  the  same,  the  water-supply,  food 
and  clothing  are  subjects  which  must  receive  his  early 
and  earnest  attention.     In  this  work  he  should  receive 


77 

the  hearty  co-operation  of  the  officers  in  command 
and  if  this  is  not  the  case  he  has  the  moral  and  mili- 
tary authority  to  demand  it.  It  was  not  the  medical 
department,  but  the  arrogance  or  stupidity  of  the  com- 
manding general  of  the  invading  army  that  is  resiDon- 
sible  for  the  extensive  outbreak  of  yellow  fever  during 
the  Cuban  campaign.  This  experience  is  sufficient  to 
teach  commanding  generals  that  it  is  unsafe  in  the 
future  to  follow  such  an  example,  as  an  imprudence  of 
this  kind,  giving  rise  to  inexcusable  slaughter  and  in- 
describable suffering,  will  meet  with  universal  indig- 
nation. The  military  surgeon  is  in  reality  the  family 
physician  of  the  men  placed  under  his  charge.  He 
attends  to  the  little  ailments  with  the  same  care  as 
though  he  had  been  sent  for  by  a  wealthy  family  and 
expected  a  handsome  fee.  To  be  successful  in  the 
treatment  of  disease  he  resorts  to  the  simplest  medi- 
cation. Complicated  prescriptions  are  dangerous  and 
absolutely  out  of  question  in  military  practice.  The 
tablets  containing  drugs  in  the  most  concentrated  form 
are  a  great  blessing  to  field  practice  and  should  be 
relied  upon  almost  exclusively  in  the  treatment  of  dis- 
ease. The  remedies  needed  are  few,  and  if  well 
chosen  and  applied  will  answer  all  indications.  A 
liberal  supply  of  quinin,  opium,  calomel,  strychnia, 
camphor,  iron,  arsenic,  bicarbonate  of  soda  and  bro- 
mid  of  potassium  will  leave  but  little  to  be  desired. 
Turpentine,  castor  oil,  alcohol  and  the  anesthetics  are 
about  the  only  fluid  medicines  the  military  surgeon 
has  any  use  for.  The  breakage  and  waste  in  dispens- 
ing medicines  in  bottles  are  inexcusable  in  modern 
field  work.  Fancy  drugs  and  preparations  should  not 
be  tolerated.  In  the  practice  of  surgery  the  military 
surgeon  who  wishes  to  attain  the  maximum  success 
must  be  conservative.  Strict  asepsis  and  conserva- 
tism are  the  two  things  which  are  destined  to  make 
miltary  surgery  successful.  Every  surgeon  must  have 
special  training  in  emergency  work.  He  must  be 
perfectly  familiar  with  the  indications  and  technique 
of  every  operation  which   may  become  necessary  in 


78 

the  field.  He  seldom  will  have  an  opportunity  to  cut 
for  stone,  extract  a  cataract,  remove  an  ovarian  tumor 
or  operate  for  other  benign  and  malignant  growths, 
but  he  must  know  how  to  treat  a  comi30und  fracture 
in  the  most  modern  and  approved  manner;  he  must 
be  skillful  in  the  treatment  of  wounds  of  all  kinds,  and 
he  must  be  a  master  in  performing  an  amputation  and 
in  ligating  arteries  in  any  part  of  the  body.  He  must 
learn  to  j^erform  all  emergency  operations  with  the 
simplest  facilities  and  fewest  instruments  possible,  in 
order  to  adapt  himself  in  time  to  the  exigencies  of 
war.  The  surgeon  who  can  extemporize  an  operating 
table  in  the  field  and  who  can  secure  asepsis  with  the 
use  of  the  camp  kettle,  soft  soap  and  carbolic  acid  or 
sublimate  and  who  can  perform  the  most  difficult  oper- 
ations with  the  simplest  and  fewest  instruments,  with 
little  or  no  assistance,  is  the  one  who  will  accomplish 
the  most  and  who  will  obtain  the  best  results  in  the 
field. 

Ponce,  Porto  Rico,  Aug.  8,  1898. 


THE  INVASION   OF  PORTO   RICO  FROM  A 
MEDICAL  STANDPOINT. 


The  occupation  of  Cuba  and  the  Philippine  Islands 
by  our  conquering  navy  and  army  in  such  rapid  suc- 
cession seemed  to  increase  the  desire  of  conquest  and 
opportunities  to  test  the  strength  of  our  arms.  With 
the  destruction  of  the  weak  navy  of  our  enemy  there 
was  nothing  in  the  way  of  sending  troops  to  any  of 
the  many  Spanish  possessions.  The  fall  of  the  heroic 
Cervera  and  his  faithful  little  band,  off  the  harbor  of 
Santiago,  before  the  murderous  fire  of  our  well- 
equii^ped  fleet  cleared  the  pathways  of  the  ocean  of 
further  sources  of  danger.  It  was  but  natural  that 
the  beautiful  island  of  Porto  Rico,  one  of  Spain's 
most  valuable  possessions,  should  have  been  selected 
by  the  military  authorities  as  the  next  objective  point 
for  contention.  Repeated  attacks  by  our  navy  on  its 
best  stronghold,  San  Juan,  had  failed  to  bring  about 
surrender  and  to  gain  a  foothold  on  Porto  Rican  soil. 
So  far  the  navy  had  taken  the  lead  in  bringing  Spain 
to  terms  and  the  army  was  anxious  to  do  its  share  in 
wresting  from  its  greedy  grasp  another  enslaved  peo- 
ple. Major-General  Miles,  who  conducted  the  inva- 
sion in  person,  decided  to  march  upon  San  Juan  from 
several  directions,  and,  after  uniting  the  forces,  attack 
the  city  jointly.  The  experience  gained  in  Cuba  had 
taught  us  an  important  lesson  in  conducting  the 
Porto  Rican  campaign.  General  Miles  laid  his  plans 
wisely  and  with  special  reference  to  gain  the  desired 
object  with  as  little  suffering  and  loss  of  life  as  possi- 
ble. Every  movement  in  this  camioaign  was  made 
with  a  due  regard  for  the  welfare  and  success  of  our 
troops  rather  than  a   desire  for  personal   gain   and 


80 

aggrandizement,  which  characterized  the  Cuban  cam- 
paign, as  every  one  knows.  He  was  well  aware  of 
the  depressing  effects  of  the  tropical  climate  on  the 
unseasoned  troops  and  of  the  necessity  of  resorting  to 
timely  and  efficient  precautions  in  preventing  disease. 
From  experience  and  personal  observations,  he  recog- 
nized the  fact  that  the  unavoidable  privations  inci- 
dent to  warfare  are  multiplied  many  times  when  the 
seat  of  war  is  a  strange  and  remote  country  present- 
ing a  climate  and  environments  unaccustomed  to  by 
the  invading  force.  His  actions  were  clean-cut 
admissions  that  he  was  in  need  of  a  medical  adviser 
and  that  they  were  influenced  by  the  frequent  con- 
sultations held  with  his  chief  surgeon.  The  war  in 
Porto  Rico  was  conducted  upon  the  most  humane 
principles,  and  although  no  great  battles  were  fought, 
victory  upon  victory  followed  the  footsteps  of  our 
army  and  in  less  than  three  weeks  our  flag  floated 
over  three  of  the  largest  cities  of  the  island.  Our 
troops  love  and  respect  their  leader  and  have  followed 
him  without  fear  and  grumbling  under  the  scorching 
sun,  full  of  confidence  and  trust.  The  news  that 
peace  had  been  declared  reached  the  headquarters  at 
Ponce,  August  14,  and  the  troops  are  now  resting  on 
their  arms  awaiting  the  final  adjustment  of  the  terms 
of  peace.  Eager  to  fight,  yet  every  soldier  in  the  field 
received  this  message  of  peace  with  joy  and  enthusi- 
asm, fully  satisfied  that  the  army  had  done  justice  to 
the  flag  and  country  it  represents.  Col.  Charles  R. 
Greenleaf,  chief  surgeon  of  the  army  in  the  field, 
accompanied  General  Miles  on  his  trip  from  Guan- 
tanamo  to  Porto  Rico,  and  has  been  with  the  army 
ever  since.  He  was  long  enough  in  Cuba  to  gain  a 
full  insight  into  the  horrors  created  by  infectious  dis- 
eases, which  so  constantly  follow  large  armies,  espe- 
cially in  a  war  of  invasion.  He  was  amazed  when  he 
saw  to  what  extent  yellow  fever  had  broken  out  in  the 
few  weeks  the  troops  had  been  in  Cuba.  There  was 
no  difficulty  in  tracing  the  disease  to  a  total  lack  of 
precaution  on  the  part  of  the  general  in  command. 


85 


have  rather  been  overzealous,  judging  from  the  num- 
ber of  insignia  displayed  and  worn.  It  was  a  com- 
mon thing  to  see  men  wear  a  white  cap  with  an  im- 
mense red  cross  on  top,  another  one  in  front,  besides 
the  brassard. 

Ponce  was  taken  and  occupied  without  any  resist- 
ance whatever.  The  citizens  received  our  soldiers 
with  enthusiasm  and  manifestations  of  joy.  General 
Miles  was  hailed  as  a  long-looked-for  friend  rather 
than   a   conqueror.    The   next  engagement  occurred 


Fever  patients  in  tlie  court  of  the  Spanish  military  hospital. 

between  Arroya  and  Guayama,  between  a  small 
Spanish  force  in  ambush  and  General  Haines'  brigade, 
and  resulted  in  eleven  wounded  on  our  side.  The  only 
death  following  this  skirmish  was  a  soldier  of  the 
Third  Illinois  Infantry  who  was  shot  accidentally  by 
an  unknown  man  of  the  Fourth  Pennsylvania  regi- 
ment. The  bullet  caused  an  extensive  non-penetrat- 
ing injury  of  the  chest,  from  the  eflPects  of  which  he 
died  the  next  day.    Such  accidents  have  occurred  too 


86 

often  during  the  present  war,  and  to  prevent  repetition 
in  the  future  this  matter  should  be  investigated,  as 
was  done  in  this  instance,  by  the  proper  authorities. 
Among  the  injured  was  a  man  who  was  shot  through 
the  pelvis  and  another  one  the  subject  of  a  gunshot 
wound  of  the  elbow  joint,  both  of  them  doing  well 
four  days  later  when  I  examined  the  wounded  in  the 
brigade  hospital  at  Guayama.  The  third  skirmish 
took  place  between  the  advance  column  of  General 
Wilson's  division,  on  the  march  to  San  Juan,  and  a 
small  Spanish  force  intrenched  on  the  summit  of  a 
high  and  steep  hill.  Lieut.  Haines,  the  son  of  Gen- 
eral Haines,  was  the  only  one  who  was  brought  on 
board  the  Relief  August  4.  One  of  the  wounded  was 
operated  on  by  Dr.  Parkhill  in  an  ambulance.  The  ab- 
domen was  torn  open  by  a  fragment  of  a  shell,  the 
intestines  protruded  and  a  resection  had  to  be  made 
of  a  loop  for  a  tearing  injury.  It  was  reported  that 
the  patient  rallied  well  from  the  immediate  effects  of 
the  operation  and  that  hopes  were  entertained  of  his 
recovery.  Another  engagement  took  place  between 
the  troops  under  command  of  General  Schwan,  on 
their  way  from  Ponce  to  Mayaguez,  and  about  1000 
Spaniards  ambushed  four  miles  from  the  latter  city. 
This  fight  resulted  in  two  killed  and  eighteen  wounded 
on  our  side.  All  of  the  wounded  were  brought  on 
board  the  hospital  ship  Relief,  which  called  at  May- 
aguez on  her  way  to  New  York,  August  15.  Such  is 
a  brief  account  of  the  casualties  sustained  by  our 
army  during  the  Porto  Rican  campaign.  The  expe- 
rience here  coincided  with  that  gained  in  Cuba,  to 
the  effect  of  confirming  the  humane  nature  of  the 
modem  weapon.  The  pro^Dortion  of  killed  to  wounded 
is  even  smaller  than  in  the  Cuban  war,  as'  well  as  the 
number  of  seriously  injured.  Thanks  to  more  elab- 
orate preparations  for  the  campaign,  the  wounded 
received  prompt  and  efficient  attention.  The  suffer- 
ing of  the  well,  sick,  and  wounded  can  not  be  com- 
pared with  what  I  saw  in  Cuba.  War  is  a  great  edu- 
cator, and  should  we  again  be  called  upon  to  invade  a 


87 


foreign  country,  we  shall  profit  by  the  experience  of 
the  past. 

TYPHOID  FEVER  IX  PORTO  RICO. 

The  native  doctors  in  Ponce,  Porto  Rico,  gave  us 
the  assurance  that  not  a  single  case  of  yellow  fever 
had  been  seen  in  that  city  for  the  last  three  years. 
We  were  informed  that  in  San  Juan  isolated  cases 
occur  from  time  to  time.  Malaria  is  present  in  all  of 
the  valleys,  more  especially  in  and   around  Ponce. 


Fever  patients  in  the  court  of  the  Spanish  military  hospital. 

The  large,  pendulous  abdomen,  and  the  pale  faces  of 
the  many  little  naked  children  in  city  and  country, 
are  the  best  witnesses  in  showing  the  prevalence  of 
malarial  intoxication. 

Typhoid  fever  is  endemic  in  certain  localities,  but 
at  present  Ponce  is  almost  free  from  this  disease. 
Having  seen  the  destruction  of  life  and  the  indescrib- 
able suffering  caused  by  yellow  fever  in  Cuba,  Col. 
Greenleaf  naturally  turned  his  attention  toward  pro- 


88 

tecting  our  troops  in  Porto  Rico  against  this  scourge. 
The  proximity  of  Porto  Rico  to  Cuba,  the  many  pos- 
sible sources  of  infection,  made  such  a  course  impera- 
tive. That  this  fear  was  not  unfounded,  and  that  the 
Chief  Surgeon  recognized  the  danger  and  made  use 
of  timely  precautions  are  but  shown  by  the  contents 
of  a  letter  addressed  to  the  Adjutant-General,  Head- 
quarters of  the  Army,  and  Circular  No.  1  issued  be- 
fore the  army  sailed  from  Guantanamo  to  Porto  Rico, 
and  a  copy  of  the  Quarantine  Regulations  formulated 
at  the  same  time. 

Headquarters  of  the  Army, 
On  board  U.S.S.  "Yale,"  en  route  to  Porto  Rico, 

July  23,  1898. 
To  the  Adjutant -General,  Headquarters  of  the  Army. 

Sir  : — I  have  the  honor  to  submit  the  following  recommenda- 
tions for  preventing  as  far  as  possible  the  introduction  of  yellow 
fever  into  the  command  now  about  to  land  on  the  island  of 
Porto  Rico  : 

The  assignment  of  an  officer  of  rank,  to  be  placed  in  com- 
mand of  the  base  of  supplies,  with  authority  to  indicate  the 
sites  to  be  occupied  by  the  various  supply  depots  and  the  hos- 
pital, and  to  enforce  the  regulations  governing  the  health  of 
the  attaches  of  these  departments  and  the  persons  who  may 
visit  them  on  business. 

The  assignment  of  a  sanitary  inspector  whose  duty  it  shall 
be  to  examine  all  vessels  and  persons  arriving  at  our  base  from 
seaward  ports,  and  to  prepare  sanitary  regulations  for  the  Gov- 
ernment of  all  transportation  and  persons  arriving  and  depart- 
ing from  the  station  by  land.  This  officer  should  have  author- 
ity to  quarantine  all  suspicious  persons  and  means  of  transpor- 
tation, and  to  disinfect  their  belongings,  either  by  fire  or  such 
other  means  as  may  be  deemed  necessary. 

All  persons  connected  with  the  Army  are  forbidden  to  enter 
any  building  whatever  on  the  island  without  express  authority 
from  these  headquarters,  and  all  buildings  in  rural  districts 
that  may  be  suspected  of  harboring  the  germs  of  disease  should 
"be  destroyed  by  fire  or  otherwise  thoroughly  disinfected. 

As  woven  goods,  particularly  those  of  woolen  fabric,  are  spe- 
cial carriers  of  disease,  the  purchase  or  acceptance  of  articles 
of  this  kind  from  stores  or  inhabitants  of  the  island  is  strictly 
forbidden.  Any  such  property  found  within  the  lines  will  be 
at  once  destroyed  and  the  holder  subjected    to  punishment. 

That  commanders  of  regiments  be  instructed  to  prepare  their 
camping  grounds  with  great  care  and  maintain  a  rigid  police  in 
them  ;  under  no  circumstances  shall  they  camp  on  ground  that 


89 


has  previously  been  occupied  either  by  troops  or  by  collective 
bodies  of  the  inhabitants. 

That  medical  officers  be  required  to  make  frequent  inspec- 
tions of  the  commands  to  which  they  belong,  and  that  any  sus- 
picious case  of  fever  be  immediately  isolated  and  the  fact  of 
its  occurrence  reported  to  these  headquarters. 

Canteens  should  be  filled  daily  with  tea  or  coffee,  and  these 
beverages  used  habitually  instead  of  water,  unless  that  has 
been  previously  boiled.        Very  Respectfully, 

Chas.  R.  Greenleaf,  Colonel, 
Asst.  Surg-C^enl.  U.S.A.,  Chief  Surg.  Army  in  the  Field. 


Ward  in  the  Spanish  military  hospital. 

Headquarters  of  the  Army, 
Office  of  the  Chief  Surgeon,  on  board  U.S.S.  "Yale," 

en  route  to  porto  rico. 
Circular  No.  1.  July  24,  1898. 

1.  Medical  officers  will,  upon  receipt  of  this  circular,  report 
to  the  Chief  Surgeon  of  the  Army  the  number  of  medical  offi- 
cers, hospital  stewards,  acting  hospital  stewards  and  privates 
of  the  Hospital  Corps  on  duty  with  their  command.  Also  the 
number  of  ambulances,  litters  and  tents,  and  if  medical  sup- 
plies are  insufficient,  note  the  general  character  needed.  This 
report  will  be  made  upon  the  following  form  : 

Com-    Med.    Hosp.    Actg.  Priv-  Lit-  Ambu-    Hosp.  Character  of  Medical 
mand.  Otfs.  Stwds.  H.  8.    ates.  ters.  lances.  Tents.     Supplies  Needed. 


90 


2.  A  field  hospital  will  be  organized  at  the  Army  base  as  soon 
as  possible  after  landing,  and  a  depot  of  supplies  will  be  con- 
nected with  it.  As  we  are  widely  separated  from  the  source 
of  our  supplies  a  strict  economy  in  their  use  is  necessary ;  Sur- 
geons of  Divisions  and  Brigades  will  give  their  personal  atten- 
tion to  this  important  subject. 

3.  Extreme  vigilance  is  enjoined  upon  Medical  Officers  in 
the  matter  of  camp  sanitation  ;  errors  in  this  particular  being 
promptly  reported  to  the  respective  commanding  officers. 

L  The  experience  at  Santiago  has  demonstrated  the  effici- 
ency of  properly  applied  first  dressings  to  gunshot  wounds ; 
these  should  be  left  untouched  unti'  the  patient  arrives  at  the 
base  hospital,  unless  the  condition  of  the  wound  absolutely 
demands  a  redressing  en  route  from  the  first  dressing  station. 
All  diagnosis  tags  will  be  marked  "Dressing  not  to  be  removed" 
or  "Redressing  required,"  as  the  condition  demands.  Unless 
an  imperative  necessity  exists,  surgical  operations  will  not  be 
attempted  at  the  front.  Chas.  R.  Greenleaf,  Colonel, 

Asst.  Surg.-Gen.  U.S.A.,  Chief  Surg.  Army  in  the  Field. 

QUARANTINE  REGULATIONS  FOR  THE  BASE  OF  THE  MILITARY  EXPE- 
DITION TO    PORTO   RICO. 

1.  Every  vessel  shall  be  officially  visited  by  the  inspector  before 
communication  is  made  with  other  vessels  or  with  the  shore. 

2.  A  vessel  having  yellow  fever  or  smallpox  on  board  shall 
not  be  allowed  to  communicate  with  the  shore,  or  with  other 
vessels,  but  shall  leave  the  island. 

,3.  Vessels  coming  from  sources  of  infection  shall  be  detained 
five  days  without  communicating  either  with  the  shore  or  with 
other  vessels.  If  at  the  expiration  of  this  time  no  cases  of 
fever  shall  have  developed,  landing  may  be  made  under  the  fol- 
lowing precautions  : 

All  fomites  shall  be  disinfected  by  one  of  the  following 
methods  :  Immersion  for  one  hour  in  1-1000  solution  bichlorid  ; 
sulphur  fuQiigation  in  a  chamber  twenty  four  hours,  four 
pounds  of  sulphur  being  used  for  each  1000  cubic  feet  of  space  ; 
or  boiling  half  an  hour  with  complete  immersion.  The  follow- 
ing need  not  be  disinfected  unless  directly  exposed  to  infection  : 

All  new  and  dry  material  unpacked,  all  iron  and  steel  imple- 
ments, all  goods  in  new  and  original  packages,  not  having  been 
broken  or  packed  in  an  infected  locality.  Goods  other  than 
textile  contained  in  textile  material,  such  as  coffee  in  sacks, 
bacon,  spices,  etc.,  kept  dry  and  not  broken  in  an  infected 
locality  do  not  require  disinfection  other  than  the  container, 
which  shall  be  treated  as  fomites  as  above.  Fruits,  sounds 
unless  exposed  in  an  infected  locality  need  no  disinfection. 
Live  stock  may  be  admitted. 

Such  ships  shall  be  thoroughly  cleaned  and  disinfected  by 
the  free  use  of  1-1000  solution  of  bichlorid,  and  by  fumigation 
with  sulphur  before  they  may  again  receive  men  or  supplies. 


91 


Ships  quarantined  shall  display  the  usual  flag,  and  those  in 
detention  shall  be  visited  by  the  inspector  daily  until  the  time 
of  quarantine  shall  have  expired. 

4.  Vessels  carrying  passengers  or  having  fomites  from  local- 
ities of  infection,  though  they  (the  vessels)  may  hail  from 
healthy  ports,  shall  be  subject  to  the  same  quarantine  restric- 
tions as  vessels  known  to  hail  from  infected  localities, 

5.  Due  precaution  shall  be  taken  to  prevent  infection  of  the 
base  of  supplies  through  communication  with  infected  localities 
along  the  line  of  march  by  teamsters  and  others.  As  far  as 
possible   they  should   not  be  allowed  to  remain  at  the  base 


Ambulance  train  transporting  the  sick  from  the  Division  Hospital  to 
the  Spanish  military  hospital. 

longer  than  necessary  to  load  and  unload,  nor  to  come  in  such 
contact  as  to  communicate  infection.  Stragglers,  prisoners 
and  strangers  should  be  immediately  sent  away, 

Chas.  R.  Greenleaf,  Colonel, 
Asst.  Surg.-Gen.  U.S.A.,  Chief  Surg,  Army  in  the  Field. 

Major  Woodbury  was  appointed  Sanitary  Inspec- 
tor. He  met  with  the  hearty  co-operation  of  the  city 
authorities  of  Ponce  in  the  performance  of  his  oner- 
ous and  often  unpleasant  duties.     The  sanitary  con- 


92 


ditions  of  the  city  underwent  a  great  improvement  in 
a  few  days.  The  water-supply  was  found  satisfactory. 
The  absence  of  a  sewerage  system  threw  many  ob- 
stacles in  the  way.  The  appearance  of  smallpox  in  a 
village  some  distance  from  Ponce  made  vaccination 
among  the  soldiers  who  were  not  protected  against  this 
disease  and  the  natives  necessary.  An  abundant  sup- 
ply of  vaccine  virus  was  on  hand  and  was  at  once 
issued  and  used.  When  I  arrived  at  Ponce,  August 
7, 1  found  typhoid  fever  raging  to  an  alarming  extent. 
It  was  desirable  to  trace  the  origin  of  the  disease. 
The  absence  of  typhoid  fever  this  season  of  the  year, 
its  outbreak  in  all  the  commands,  and  the  short  time 
that  had  intervened  between  leaving  the  United  States 
and  the  landing  in  Porto  Rico  made  it  probable  that 
the  disease  could  be  traced  to  the  infected  camps 
occupied  by  the  troops  before  leaving  for  Porto  Rico. 
General  Miles  was  very  anxious  to  obtain  reliable 
information  regarding  the  origin  and  spread  of  the 
disease.  Pursuant  to  the  following  order  I  made  an 
exhaustive  and  systematic  investigation: 
Headquarters  of  the  Army,  Office  of  the  Chief  Surgeon. 

Port  Ponce,  Porto  Rico,  Aug.  10,  1898. 
Lieut.-Col.  Nicholas  Senn,  Surgeon  U.  S.  V.,  Chief  of  Oper- 
ating Staff  of  the  Army. 

Sir  : — You  will  proceed  to  the  town  of  Ponce,  visit  the  mili- 
tary and  other  hospitals  in  that  town,  and  such  of  the  camps 
in  its  vicinity  as  you  may  deem  necessary,  for  the  purpose  of 
investigating  and,  if  possible,  determining  the  cause  of  typhoid 
and  other  fevers  now  prevailing  in  this  army,  and  report  the 
results  of  your  investigation  in  writing  to  me.  Should  you 
find  it  necessary  to  have  the  services  of  an  interpreter,  or  other 
civilian,  to  aid  in  your  work,  you  are  hereby  authorized  to 
employ  him,  sending  the  bill  to  this  office  for  payment. 
Very  respectfully, 

Chas.  R.  Greenleaf,  Colonel, 
AsBt.  Surg.  Gen.  U.S.A.,  Chief  Surg.  Army  in  the  Field. 

I  obtained  accurate  information  of  two  hundred 
fever  patients,  of  which  number  more  than  90  per 
cent,  were  well-marked  typhoid  fever,  the  balance 
malaria  and  the  results  of  sunstroke.  I  estimated  the 
whole  number  of  fever  patients  in,  and  in  the  imme 


93 


diate  vicinity  of,  Ponce  at  250.  In  extending  my 
inquiries  to  General  Brooke's  command,  with  head- 
quarters at  Guayama,  I  found  about  145  additional 
cases;  however,  in  that  locality  malaria  seemed  to 
predominate.  Most  of  the  cases  came  from  Chicka- 
mauga  by  way  of  Charleston  and  Newport  News. 
The  Second  and  Third  Wisconsin  Regiments  fur- 
nished the  largest  contingent.  Almost  every  soldier 
in  the  diflPerent  hospitals  belonging  to  either  of  these 


Ambulance  unloading  the  sick  at  the  door  of  the  Club  House  in  Ponce 
used  as  a  temporary  hospital. 

regiments  suffered  from  typical  typhoid  fever,  and 
what  attracted  my  attention  was  that  the  disease 
appeared  to  be  of  a  more  serious  type  than  in  most 
of  the  men  belonging  to  other  regiments.  The  local- 
ity from  which  these  regiments  came,  when  encamped 
at  Chickamauga,  must  have  been  badly  infected.  As 
the  result  of  my  investigations,  I  reported  to  Col. 
Greenleaf  the  number  of  cases  found,  and  that  in  my 
opinion  the  disease  was  contracted  in  every  instance 


94 


before  leaving  the  camps  in  the  United  States.  In 
view  of  the  fact  that  most  of  the  cases  came  from 
Chickamauga,  I  suggested  at  the  same  time  that  the 
Medical  Department  should  recommend  immediate 
evacuation  of  that  camp.  In  Ponce  most  of  the  cases 
found  shelter  and  care  in  the  Spanish  military  hospi- 
tal, then  in  charge  of  Major  Ten  Eyck,  U.  S.  A.  The 
club-house  and  a  school  for  girls,  of  the  Sisters  of 
Charity,  were  also  placed  at  the  disposal  of  the  chief 
surgeon  and  were  sooa  filled  with  patients.  Miss 
Chancellor  of  New  York  did  excellent  service  as  a 
nurse  in  the  former  temporary  hospital.  A  conges- 
tion which  occurred  in  the  military  hospital,  and  which 
could  not  be  prevented,  took  place  when  General  Wil- 
son's division  moved  forward  and  unloaded  at  the 
door  all  of  the  sick  in  the  Division  hospital,  some  150 
in  number.  The  overcrowded  condition  was  reme- 
died the  next  day,  when  a  large  number  of  the  more 
grave  cases  were  sent  on  board  the  Belief,  anchored 
in  the  harbor  of  Ponce.  Medical  supplies  were  in 
abundance  at  all  times  and  were  freely  issued  without 
any  formality..  The  Relief,  and  later  the  yacht  3Iay, 
brought  an  additional  supply,  with  many  delicacies 
for  the  sick.  Milk  was  bought  and  freely  supplied  to 
the  sick.  It  is  the  irtention  of  the  chief  surgeon  to 
establish  an  extensive  out-door  receiving  hospital  as 
soon  as  the  tentage  arrives,  which,  according  to  infor- 
mation received  from  the  Surgeon -General,  is  now  on 
the  way.  The  number  of  new  cases  of  typhoid  fever 
in  the  Porto  Rican  army  will  probably  be  a  limited 
one,  and  if  the  troops  are  recalled  as  soon  as  the  treaty 
of  peace  has  been  signed,  we  need  to  entertain  little 
fear  of  the  indigenous  spread  of  the  disease. 
Arroya,  Porto  Rico,  Aug.  12,  1898. 


TYPHOID  FEVER    IN    THE    PORTO   RICAN 
CAMPAIGN. 


In  Cuba  our  army  met  as  its  most  formidable  enemy 
one  of  the  most  dreaded  of  all  infectious  diseases- 
yellow  fever.  The  Cuban  invasion  was  characterized 
by  hasty  action,  a  lack  of  organization,  and  inadequate 
preparation.  The  last  crippled  the  medical  depart- 
ment and  is  responsible  for  the  early  and  extensive 
outbreak  of  yellow  fever.  In  less  than  two  weeks 
after  our  army  landed  in  Cuba,  yellow  fever  made  its 
appearance,  and  almost  simultaneously  attacked  the 
troops  from  Siboney,  the  base  of  invasion,  to  the 
trenches  before  Santiago.  In  less  than  two  weeks 
from  its  appearance  nearly  500  fever  cases,  most  of 
them  yellow^  fever,  impaired  the  fighting  force  and 
seriously  taxed  the  limited  resources  of  the  medical 
department.  Fortunately  for  the  army,  that  type  of 
the  disease  was  mild,  the  number  of  deaths  few  as 
compared  with  some  of  the  epidemics  in  the  past. 
Under  the  circumstances,  it  was  fortunate  that  Santi- 
ago surrendered  in  time,  as  the  fighting  force  was 
being  rapidly  reduced  by  the  invasion  of  yellow  fever 
and  the  ever-present  malaria.  In  planning  the  Porto 
Rican  invasion  the  possible  repetition  of  a  similar 
experience  was  taken  into  due  consideration,  and 
timely  precautions  against  such  an  occurrence  were 
adopted  and  carried  into  effect.  So  far  our  troops  in 
Porto  Rico  have  escaped  yellow  fever,  but  soon  after 
their  landing,  fever  cases  came  into  the  hospitals  at 
an  alarming  rate.  Many  of  the  soldiers  were  attacked 
on  the  transports  or  soon  after  landing.  After  land- 
ing in  Ponce,  August  8,  I  found  at  least  250  cases  of 
fever  in  the  different  hospitals  in   the   city  and  the 


96 

division  hospital  near  the  city  limits.  Even  a  super- 
ficial examination  sufficed  to  prove  that  most  of  the 
cases  were  typhoid  fever.  The  time  which  intervened 
between  the  departure  of  the  troops  from  the  United 
States  and  the  appearance  of  fever,  made  it  more  than 
probable  that  the  infection  did  not  have  an  indigenous 
origin.  In  some  of  the  cases  it  was  difficult,  in  others 
impossible,  to  make  a  differential  diagnosis  between 
malaria  and  typhoid  fever  without  the  use  of  the 
microscope,  and  this  invaluable  diagnostic  resource 
in  such  cases  was  unfortunately  not  at  hand.  Another 
difficulty  we  had  to  contend  with  was  the  lack  of 
recorded  thermometric  observations,  which,  when 
accurately  made  and  systematically  recorded,  prove  of 
such  signal  service  in  distinguishing  between  these 
two  febrile  conditions. 

Pursuant  to  an  order  issued  by  Col.  Greenleaf,  chief 
surgeon  of  the  army  in  the  field,  I  investigated  for 
two  consecutive  days  all  of  the  fever  cases  then  in 
the  hospitals,  for  the  purpose  of  locating  the  origin  of 
typhoid  fever.  In  this  work  I  availed  myself  of  the 
kind  and  able  assistance  of  Dr.  M.  O.  Terry,  Surgeon- 
General  of  the  State  of  New  York,  and  Acting  Assis- 
tant-Surgeon Greenleaf,  son  of  the  chief  surgeon. 
We  made  a  careful  examination  of  200  cases  of  fever 
as  they  presented  themselves,  noted  the  principal 
symptoms  and  tabulated  them  (see  appended  table). 

A  careful  study  of  these  cases,  as  well  as  subse- 
quent developments,  furnished  adequate  proof  that 
90  per  cent,  of  them  were  genuine  typhoid  fever.  No 
further  doubt  could  remain  in  tracing  the  infection  to 
the  camps  occupied  in  the  United  States.  The  great 
prevalence  of  the  disease  among  the  troops,  affecting 
as  it  did,  more  or  less,  all  of  the  regiments,  was  a 
source  of  uneasiness  and  anxiety  on  the  part  of  those 
who  were  in  charge  of  the  invasion.  Measures  were 
taken  to  secure  ample  hospital  room  and  facilities  for 
the  accommodation  and  proper  treatment  of  those  on 
hand  and  such  as  might  be  brought  in  later.  The 
order  to  General  Wilson  to  take  up  the  march  toward 


97 

San  Juan  made  it  necessary  to  evacuate  the  division 
hospital.  All  of  the  patients  were  transferred  to  the 
Spanish  military  hospital  in  Ponce,  which  caused  the 
temporary  overcrowding  to  which  I  referred  in  a  for- 
mer communication.  The  Spanish  military  hospital 
is  a  substantial,  square,  one-story  building  with  a  large 
court  in  the  center.  It  is  built  of  stone,  the  floors 
being  made  of  cement  or  brick  tiling.  It  is  on  a  high 
hill  near  the  city  limits,  from  which  a  magnificent 
view  of  the  city,  harbor  and  surrounding  country  can 
be  obtained.  It  has  a  capacity  for  about  150  beds. 
It  required  a  good  deal  of  labor  to  make  this  building 
fit  for  the  reception  of  patients.  Major  Dooly  and 
his  force  worked  persistently  a  whole  day  in  removing 
the  dirt  and  filth  which  the  Spaniards  had  left,  in 
their  haste  in  evacuating  the  city,  as  an  undesirable 
legacy.  The  hospital  was  at  once  supplied  with  cots, 
bedding  and  hospital  stores.  The  club-house  of  the 
city,  and  a  school  for  girls  in  charge  of  the  Sisters  of 
Charity,  were  otfered  to  the  authorities  for  hospital 
use,  and  courtesy  was  promptly  accepted.  For  over  a 
week  the  sick  officers  occupied  the  club-house  and 
about  fifty  patients  found  comfortable  quarters  and 
excellent  treatment  in  the  school-house.  Ponce  has 
a  large  charity  hospital,  the  "Tricoche,''  with  200 
beds,  under  the  care  and  management  of  the  Sisters 
of  Charity.  The  hospital  is  a  model  of  cleanliness 
and  comfort.  Col.  Greenleaf  made  arrangements  with 
the  city  authorities  to  open  the  doors  of  this  excellent 
institution  for  sick  officers.  I  am  sure  that  every  one 
who  will  enjoy  the  kind  treatment  and  excellent  care 
of  the  Sisters  in  these  great  institutions  of  charity 
will  have  a  good  word  for  this  ancient  and  worthy 
order.  Out  of  the  200  cases  of  fever  examined  in  the 
different  hospitals  in  Ponce,  and  which  appear  in  the 
table,  the  following  diagnoses  were  made  at  the  time: 
Gastric  fever,  2;  effects  of  sunstroke,  6;  malaria,  9; 
doubtful,  21;  typhoid  fever,  162— total,  200. 

I  am  satisfied  that  of  the  doubtful  cases  a  sufficient 
number  developed  typhoid  fever  to  bring  the  whole 


98 

number  of  cases  up  to  280.  In  reference  to  the  time 
the  disease  developed  the  following  can  be  gleaned 
from  the  table :  The  first  symptoms  appeared  before 
leaving  the  United  States,  8;  on  transports,  86;  within 
ten  days  after  landing,  68,  out  of  a  total  of  162. 

As  regards  the  place  of  infection  the  cases  came 
from:  Chickamauga,  90;  Tampa,  48;  Camp  Alger,  23, 
Newport  News,  1 — total,  162. 

The  small  number  coming  from  Camp  Alger,  where 
the  disease  gained  such  a  firm  foothold,  which  led  to 
the  abandonment  of  the  camp,  is  to  be  explained  by 
the  fact  that  a  large  number  of  fever  cases,  coming 
from  that  camp,  were  returned  to  the  United  States 
soon  after  landing,  by  order  of  Col.  Greenleaf .  All 
regiments  were  not  affected  alike  by  this  disease. 
Among  the  troops  in  Porto  Rico  the  typhoid  fever 
cases  were  distributed  as  follows: 

2d  Wisconsin , 42 

3d  Wisconsin 17 

16th  Pennsylvania 17 

6th  Massachusetts 15 

19th  U.  S.  Infantry 15 

6th  Illinois 11 

3d  Artillery 10 

4th  Artillery. 5 

11th  U.  S.  Infantry 5 

1st  Provisional  Corps 4 

Hospital  Corps 4 

17th  U.  S.  Infantry 3 

2d  Cavalry 3 

5th  Cavalry 3 

3d  Illinois 4 

4th  Pennsylvania 2 

Signal  Corps.  ...  2 

5th  Artillery 1 

Total 162" 

In  tabulating  the  symptoms  the  following  facts 
appear : 

['Dry,  coated,  red  at  tip  and  margin.     10. 
I  Coated,  white  fur.     21. 
I  Coated,  pale,  flabby.     17.    . 
Tongue.     ■{  Coated,  red  tip  and  margin.     56. 
I  Dry,  brown  and  fissured.     20. 
!  Moist,  glazed,  red.     13. 
l^Sordes,  lips  and  teeth.     12. 


99 


f  Tympanites.     29. 

!  Tenderness  and  gurgling  right  iliac  fossa.     71. 
Abdomen.  {  Rose  spots.     37. 

I  Spleen  enlarged.     141. 

I  Spleen  markedly  enlarged.     20. 

Epistaxis  during  prodromal  stage 28 

Diarrhea 87 

Intestinal  hemorrhage 3 

Bronchitis 20 

Delirium 1 

The  absence  of  delirium  in  all  cases  but  one  is 
remarkable,  but  it  must  not  be  forgotten  that  nearly 
all  of  the  cases  were  examined  during  the  early  stages 
of  the  disease.  In  quite  a  number  of  cases  this  symp- 
tom appeared  later.  From  the  symptoms  and  the 
death-rate,  ascertainable  at  this  time,  it  is  evident  that 
the  disease  pursued  a  comparatively  mild  course. 
Nearly  200  of  the  more  grave  cases  were  transferred 
to  the  hospital  ship  Belief,  which  sailed  from  Ponce 
for  New  York  August  35.  Of  this  number  fourteen 
died  en  route  and  twelve  were  buried  at  sea.  In  two  of 
these  cases  death  resulted  from  complications.  In 
one  case  gangrene  of  the  penis,  which  assumed  a  pro- 
gressive form,  was  the  direct  cause  of  death.  In  one 
case  a  fatal  termination  threatened  during  the  third 
week  of  the  disease  from  laryngitis  and  lobular  pneu- 
monia. A  metastatic  abscess  of  the  submaxillary 
gland,  which  developed  in  one  case,  deserves  mention 
as  a  rare  complication  of  typhoid  fever. 

RETURN  OF  THE  HOSPITAL  SHIP  "  RELIEF  "  FROM 
PORTO  RICO. 

The  Relief  sailed  from  Ponce,  Porto  Rico,  August 
15,  for  New  York,  and  called  on  her  way  at  Mayaguez 
to  complete  her  precious  cargo  of  sick  and  wounded. 
All  of  the  wounded  at  the  last  port  were  taken  on 
board.  The  entire  number  of  patients  on  leaving 
Porto  Rico  was  255,  the  full  capacity  of  the  floating 
hospital.  It  is  probably  the  first  time  in  the  history 
of  the  world  that  so  many  fever  cases  were  treated  on 
a  hospital  ship  and  conveyed  from  a  foreign  country 
to  their  homes.     The   first   day   out  a  brisk  breeze 


100 

caused  considerable  rolling  and  pitching  of  the  ship, 
which  induced  some  cases  of  seasickness  among  the 
patients,  but  did  not  seem  to  unfavorably  influence 
the  disease.  The  female  nurses  worked  faithfully  and 
proved  of  the  utmost  value  to  the  sick.  Fourteen  of 
the  more  severe  cases  of  typhoid  fever  died  on  the 
way  to  New  York.  Many  of  the  patients  improved 
rapidly  during  the  voyage.  The  Relief  has  done  all 
and  more  than  was  expected  in  serving  as  a  temporary 
hospital  and  as  an  ambulance  ship  in  the  treatment 
and  transportation  of  the  sick  and  wounded. 

New  York,  Aug.  20,  1898, 


ii 

If?. 

If 


k 


n 


III 


^11:::;^ 


irv   :  liiil^ri  1-1 1  i"-"-    w  ^Sagjaa 


THE  RETURNING  ARMY. 


The  war  is  over  and  the  heroes  who  freed  the  West- 
ern Continent  from  Spanish  despotism  are  returning 
home.  The  first  war  of  invasion  on  our  part  has  been 
a  short,  decisive  one.  Only  four  months  have  passed 
by  since  the  Chief  Executive  issued  the  first  call  to 
arms,  and  more  than  we  expected  has  been  accomp- 
lished. The  outside  world,  which  has  sneered  too 
long  at  our  fighting  strength  as  a  nation,  has  been 
convinced  that  it  is  dangerous  to  trifle  with  Ameri- 
cans in  matters  of  war.  In  less  than  two  months  after 
war  was  declared  we  had  more  than  two  hundred 
thousand  men  in  the  field,  eager  and  anxious  to  face 
the  dangers  of  active  warfare.  Less  than  one-half  of 
this  army  took  part  in  the  invasion.  The  enemy's 
navy  was  entirely  destroyed;  not  a  single  ship  that 
came  within  range  of  our  guns  escaped.  The  proud 
Spanish  fleet  is  a  total  wreck  in  American  waters,  a 
source  of  pride  to  our  navy  and  a  significant  object 
lesson  for  all  foreign  nations.  Santiago  fell  before 
our  victorious  army;  Porto  Rico  yielded  after  a  few 
skirmishes  and  Spain  accepted  our  terms  of  peace 
without  much  argumentation,  after  the  hopelessness 
of  her  cause  had  been  demonstrated  by  our  invincible 
army  and  navy.  Peace  has  been  restored,  and  the 
returning  soldiers  of  the  volunteer  army  will  soon 
return  to  citizenship  and  resume  their  ordinary  voca- 
tions of  peaceful  life. 

What  a  contrast  between  the  invading  and  return- 
ing army!  This  contrast  has  reference  not  only  to 
size  but  also  to  appearance.  Thousands  have  died 
from  wounds  and  disease.  Yellow  fever,  dysentery, 
malaria  and  typhoid  fever  have  been  and  continue  to 
be  our  most  formidable  enemies.     We  had  no  great 


102 

difficulty  in  silencing  the  Spanish  guns,  but  we  have 
been  less  effective  in  preventing  the  origin  and  spread 
of  these,  the  greatest  terrors  of  camp  life.  We  can 
calculate  with  some  degree  of  precision  the  loss  of  life 
sustained  in  battle,  but  it  is  impossible  today  to  esti- 
mate the  ultimate  damage  inflicted  by  disease.  The 
naval  forces  scored  the  greatest  victories  with  little 
loss  of  life;  they  escaped  disease  and  its  consequences, 
to  a  large  extent,  and  were  subject  to  little  or  no  pri- 
vations. The  invading  armies  suffered  the  brunt  of 
privation  and  discomforts  incident  to  an  active  cam- 
paign. The  troops  in  camps  who  were  denied  the 
privilege  of  taking  part  in  the  invasion  of  Cuba  and 
Porto  Rico  had  their  share  of  deaths,  sickness  and 
hardship.  It  is  safe  to  say  that  not  half  of  the  soldiers 
engaged  in  this  short  war  are  in  a  fighting  or  working 
condition  on  their  return  home.  It  is  a  sad  sight, 
indeed,  to  witness  the  disembarkment  of  a  transport 
arriving  from  Cuba  or  Porto  Rico.  Every  one  of  the 
vessels  brings  from  fifty  to  one  hundred  and  fifty  dis- 
abled men  requiring  medical  treatment.  All  of  the 
men  left  on  the  outgoing  transports  in  good  health 
and  cheerful  mood;  all  who  arrive  show  the  effects  of 
the  campaign.  Many  have  died  in  our  new  posses- 
sions, many  have  been  consigned  to  the  sea  on  their 
way  home,  others  have  reached  the  shore  in  a  dying 
condition.  The  crowded  transports,  the  inadequate 
provisions  for  proper  food,  have  made  the  voyages  to 
and  from  the  seat  of  war  a  source  of  hardship  instead 
of  health  and  pleasure.  The  emaciated  forms,  the 
sunken  eye,  the  hollow  cheek,  the  pale,  bronzed  faces, 
tlie  staggering  gait,  show  only  too  plainly  what  can 
be  done  by  disease,  a  tropic  climate  and  improper 
food  in  disabling  an  army  in  a  few  weeks.  In  this 
respect  our  experience  is  a  repetition  of  that  of  our 
enemy.  It  is  well  known  that  the  Spanish  army  lost 
50  per  cent,  of  its  fighting  force  from  the  same  cause 
in  two  months  after  landing  in  Cuba.  The  Spanish 
surgeon  I  met  inside  of  the  lines  of  the  enemy,  four 
days  before  the  surrender  of  Santiago,  when  we  deliv- 


103 

ered  to  him,  under  a  flag  of  truce,  sixteen  wounded 
Spanish  soldiers,  informed  me  that  when  his  part  of 
the  army  reached  Cuba  the  men  were  all  in  good 
health,  and  that  now  many  were  sick  and  none  well. 
He  drew  a  sad  picture  of  how^  their  ranks  were 
thinned  out  by  yellow  fever,  malaria  and  dysentery. 
The  outbreak  and  spread  of  typhoid  fever  in  our 
home  camps,  so  early  during  the  campaign,  is  respon- 
sible for  more  deaths  and  suffering  than  any  other 
cause.  Many  of  our  soldiers  carried  the  infection 
with  them  to  Cuba  and  Porto  Rico,  and  were  taken 
ill  on  the  transports  or  soon  after  landing.  It  is 
much  more  difficult  to  keep  typhoid  fever  out  of  the 
army  than  yellow  fever.  The  yellow  fever  which  our 
troops  in  Cuba  encountered  was  of  a  mild  type. 
Comparatively  few  died  and  most  of  the  cases  recov- 
ered after  an  illness  of  but  a  few  days.  Typhoid  fever 
runs  its  typic  course  of  three  weeks  or  more,  little 
influenced,  as  far  as  time  is  concerned,  by  medication. 
It  is  a  disease  which,  above  all  others,  requires  care- 
ful nursing.  The  necessary  attention  to  typhoid- 
fever  patients  in  nursing  and  treatment  is  a  matter 
difficult  to  obtain,  even  in  a  well- equipped  hospital 
with  all  needful  appliances.  The  management  of 
such  cases  in  field  hospitals  is  necessarily  attended  by 
many  difficulties  which  tax  to  the  utmost  the  experi- 
ence of  the  medical  staff  and  nursing  corps.  Consid- 
ering the  limited  resources  at  our  command  in  the 
treatment  of  this  disease,  in  our  home  camps  and  our 
new  possessions,  it  is  surprising  that  the  mortality 
has  not  been  greater.  The  Sisters  of  Charity  and  the 
trained  female  nurses  from  different  cities,  have  done 
most  satisfactory  work  in  our  home  camps,  crowded 
with  typhoid  fever  patients.  Many  a  soldier  on  his 
recovery  from  the  disease  will  feel  grateful  for  their 
faithful  services. 

CAMP    WIKOFF. 

Camp  Wikoff  is  now  a  great  hospital.  It  is  located 
on  Montauk  Point,  L.  I.,  a  narrow  strip  of  land  sur- 
rounded on  both  sides  by  salt  water.     The  country  is 


104 

hilly  and  treeless  and  the  sandy  soil  is  covered  with  a 
scanty  growth  of  grass.  Between  the  hills  are  cup- 
shaped  depressions  with  a  marshy  soil,  which  after 
rains  are  filled  with  stagnant  water.  These  diminu- 
tive marshes  threaten  danger  in  case  of  a  prolonged 
encampment.  They  are  undoubtedly,  all  of  them, 
the  natural  breeding-places  of  the  plasmodium  mala- 
rise.  They  will  soon  become  contaminated  with  the 
fecal  discharge  from  hundreds  of  typhoid  fever  cases, 
as  many  of  the  sinks  drain  directly  into  them.  I  am 
told  that  the  water-supply  from  the  artesian  wells, 
while  not  ample,  is  otherwise  satisfactory.  The  small 
railroad  which  terminates  here  from  New  York, 
monopolizes  the  whole  business  of  transportation,  as 
this  exclusive  right  was  made  conditional  in  securing 
the  ground  for  camp  purposes.  This  is  greatly  to  be 
regretted,  as  steamer  communication  could  be  readily 
established,  which  would  facilitate  the  present 
unusually  large  passenger  and  freight  business  be- 
tween the  camp  and  New  York.  Politics  and  personal 
interests  have  figured  conspicuously  in  the  manage- 
ment of  the  present  war.  Departments  have  been 
severely  criticised,  when  a  thorough  investigation 
would  often  reveal  a  power  behind  the  throne.  If  we 
had  steamer  traffic  between  here  and  New  York  we 
would  not  have  to  wait  for  days  for  the  so  much 
needed  supplies.  The  little  railroad  has  had  sufficient 
influence  in  cutting  oflp  competition  and  in  increasing 
correspondingly  the  value  of  its  stock,  and  we  here 
are  suffering  the  consequences  of  this  Judas  Iscariot 
bargain.  The  whole  little  peninsula  is  a  tented  field. 
Regiment  after  regiment  is  arriving,  day  after  day, 
seriously  testing  the  quartermaster's  department.  All 
the  troops  that  came  from  Cuba  must  land  here  to 
comply  with  the  quarantine  regulations.  A  detention 
hospital  has  been  established  near  the  landing,  to 
which  all  suspects  are  consigned  for  the  required 
length  of  time.  Near  the  hospital  a  large  disinfect- 
ing plant  has  been  erected.  So  far  no  cases  of  yellow 
fever  have  been  imported.     The  general  hospital  con- 


105 

tains  at  the  present  time  (August  26)  nearly  one 
thousand  patients  and  all  the  sick  iu  the  camp  will 
swell  the  number  to  1500.  The  landing  of  so  many 
sick  in  such  a  short  time  has  brought  about  an  over- 
crowding which,  with  the  present  facilities  and  re- 
sources could  not  have  been  prevented.  Colonel  For- 
wood,  Assistant  Surgeon-General,  selected  the  camp 
site,  and  was  the  first  man  on  the  ground.  His 
immense  military  experience,  gained  during  the  War 
of  the  Rebellion,  fitted  him  in  an  admirable  way  for 
the  difficult  task  imposed  upon  him.  Colonel  For- 
wood  is  an  authority  in  military  surgery  and  endowed 
with  excellent  administrative  talents.  His  work  here 
will  be  the  crowning  effort  of  his  life.  He  has  worked 
night  and  day  since  he  has  assumed  his  duties  here. 
He  is  a  friend  of  the  soldier  and  will  not  leave  a 
stone  unturned  to  be  of  service  to  him.  He  has  exclu- 
sive charge  of  the  hospital  construction,  and  his  work 
was  much  admired  by  tw^o  staff  surgeons  of  the  Ger- 
man army,  Drs.  Steinbach  and  Wildemann,  and  by^ 
Lieutenant-Commander  Tomatsuri  of  the  Japanese 
navy,  w^ho  came  from  New  York  to  the  camp  with  me. 
As  they  expressed  themselves,  the  field  hosjDitals  here 
were  the  best  they  had  ever  seen.  Colonel  Forwood 
is  ably  assisted  in  his  arduous  duties  by  Majors  Heitz- 
mann.  Brown,  Nancrede  and  Wing  and  a  large  staff  of 
acting  assistant-surgeons.  The  writer,  on  his  arrival, 
was  placed  in  charge  of  the  surgical  work.  An  oper- 
ating tent  w^as  erected  and  placed  in  working  order 
with  the  assistance  of  two  Sisters  of  Charity  and 
Acting  Assistant-Surgeon  Greenleaf.  The  tent  is 
floored  and  divided  into  four  sections.  The  front  part 
is  the  operating-room,  with  two  side  tables  two  feet 
in  width  the  whole  length  of  the  room.  The  tables 
are  covered  with  rubber  cloth.  An  army  operating- 
table  and  a  few  stands  constitute  the  balance  of  the 
furnishing  of  the  room.  The  next  section  is  open  on 
the  sides  to  allow  a  free  current  of  air  and  serves  as 
an  office.  The  next  compartment  is  the  preparation- 
room,  fitted  out  with  formaldehyde  and  steam  steri- 


106 

lizers  and  sufficient  shelf  accommodations.  The  last 
section  is  used  as  a  storeroom  for  dressings,  splints, 
antiseptics  and  drugs  necessary  for  the  treatment  of 
surgical  cases. 

Gen.  Joseph  Wheeler  is  in  command  of  the  camp, 
and  although  debilitated  by  the  campaign  and  disease, 
he  attends  to  his  duties  wtth  a  regularity  and  devo- 
tion which  have  characterized  his  whole  military^ 
career.  The  sick  are  being  cared  for  at  the  present 
time  by  fifty  Sisters  of  Charity  and  sixty  trained 
female  nurses.  One  of  the  things  that  was  greatly 
admired  by  the  foreign  military  surgeons  was  the 
efficient  work  of  the  hospital  corps.  They  were 
charmed  with  the  way  in  which  the  patients  were 
handled  and  the  gentlemanly  conduct  of  the  litter- 
bearers.  Less  praise  was  bestowed  on  the  military 
bearing  of  the  men  in  camp,  from  the  highest  officers 
to  the  ordinary  private.  The  military  spirit  seems 
to  have  been  fully  subdued  in  the  enemy's  country. 
The  sentries  move  about  sluggishly  and  seldom  deem 
it  worth  while  to  come  to  a  "present  arms,"  no  matter 
who  may  come  within  saluting  distance.  Men  walk 
about  in  clothes  showing  only  too  distinctly  the 
absence  of  whisk-broom  or  brush  since  they  left  Cuba. 
Guns,  bayonets  and  scabbards  have  become  rusty  and 
show  an  entire  lack  of  proper  care.  All  drills  are  sus- 
pended and  the  whole  camp  presents  more  the  appear- 
ance of  a  picnic  ground  than  a  military  post.  Officers 
and  men  are  evidently  impressed  with  the  idea  that 
their  work  is  done,  and  while  away  their  time  in  a 
way  requiring  the  least  amount  of  energy  and  exertion 
possible.  In  this  respect  our  troops  form  a  strong 
contrast  with  the  German  army  when  it  entered  Paris, 
after  one  of  the  most  bloody  wars  and  after  a  prolonged 
siege  full  of  hardship  and  privations.  On  that  occa- 
sion every  soldier  was  in  a  condition  to  go  on  parade 
and  to  pass  with  credit  the  inspection  of  the  most 
exacting  officer.  Such  looseness  of  discipline  as  seen 
here  at  this  time  is  not  calculated  to  inspire  the  out- 
going army  with  the  proper  military  spirit  that  should. 


107 

be  maintained  and  cultivated  under  the  most  adverse 
oircum stances.  Strict  military  bearing  is  also  sadly 
lacking  among  the  medical  officers — a  source  of  dis- 
appointment and  surprise  to  the  corps  of  acting 
assistant- surgeons,  who  entered  the  service  with  the 
full  expectation  that  the  reverse  would  be  the  case. 
Camp  Wikoff,  Montauk,  N.  Y.,  Aug.  27,  1898. 


THE  NATIONAL  CRY. 


Unrest,  criticism  and  grumbling  are  the  accom- 
paniments and  heritage  of  every  war.  These  symp- 
toms of  war  fever  have  been  unusually  well  developed 
during  the  war  just  ended,  and  they  will  be  discussed 
for  a  long  time  after  the  treaty  of  peace  has  been 
signed.  After  an  uninterrupted  reign  of  peace  for 
more  than  thirty  years,  the  war  cloud  that  came  upon 
us  so  suddenly  and  unexpectedly  provoked  a  commo- 
tion among  the  people  unparalleled  in  degree  and 
extent  since  the  War  of  the  Rebellion.  All  eyes  were 
turned  in  the  direction  of  the  seat  of  war,  and  the 
contents  of  our  enterprising  and  prolific  newspapers 
were  devoured  with  an  eagerness  unknown  in  any 
other  country.  It  is  strange  that  with  all  this  great 
national  unrest  the  current  of  commerce  and  business 
pursued  its  natural  course.  While  our  troops  were 
engaged  in  war  in  foreign  lands,  the  tilling  of  the 
soil,  the  hum  of  industry  and  the  ordinary  avocations 
of  life  continued  as  though  harmony  and  peace 
reigned  universal.  The  American  never  forgets  that 
patriotism  is  not  limited  to  the  battlefield.  The  con- 
scientious performance  of  duties  at  home,  the  fireside, 
the  farms,  the  workshops,  the  manufacturing  and  busi- 
ness places,  is  one  of  the  things  ^essential  in  the  suc- 
cessful prosecution  of  a  war.  This  fact  was  recognized 
by  our  people,  and  the  result  has  been  that  the  pros- 
perity of  our  country  has  suffered  little,  if  any,  during 
our  first  war  of  invasion.  Criticism  is  a  part  of  human 
nature.  It  is  seen  everywhere.  It  affects  the  educated 
as  well  as  the  ignorant,  it  extends  from  the  cradle  to 
the  grave,  it  involves  one  sex  as  much  as  the  other,  it 
moves  the  well  as  much  as  the  sick,  it  infects  the  pulpit 
as  well  as  the  stage,  and  it  comes  to  the  surface  in  the 


109 

army  from  the  commanding  general  down  to  the  lowest 
of  all  privates.  It  is  amusing  to  listen  at  a  camp  fire 
to  the  remarks  made  from  all  sources  as  to  how  the  cam- 
paign should  be  conducted.  The  average  private  dis- 
cusses the  most  complicated  strategic  problems  with  an 
ease  as  though  he  were  repeating  the  multiplication 
table  or  the  Lord's  prayer.  The  generals  high  in  com- 
mand ease  their  conscience  by  criticising  their  subordi- 
nates most  unmercifully,  if  any  thing  has  gone  wrong. 
Wise  as  well  as  ignorant  men,  a  thousand  miles  away 
from  the  seat  of  war,  have  their  convictions  as  to 
what  should  be  done  and  are  free  to  express  them. 
Criticism  increases  in  severity  and  extent  in  propor- 
tion as  confidence  is  weakened  and  undermined.  As 
we  live  in  a  free  country  criticism  finds  a  fertile  and 
productive  soil  everywhere  and  anywhere.  The  un- 
bridled liberty  of  the  press  encourages  and  fosters  it. 
Like  swearing  and  other  vices  it  is  engendered  by 
environments.  Just  and  wrathful  criticism  is  legiti- 
mate; criticism  the  outpouring  of  impure  selfish  mo- 
tives is  baneful.  Our  energetic,  ei^thusiastic  press  is 
entitled  to  a  great  deal  of  credit  in  giving  to  the  pub- 
lic the  war  news  so  promptly  and  completely,  often  at 
an  enormous  expense  and  severe  danger  to  life.  The 
American  reporter  has  no  equal  in  any  country  for 
obtaining  news  regardless  of  cost  and  risk.  The 
reporters  not  only  culled  the  news,  but  often  took  a 
hand  in  supplying  the  sick  and  wounded  with  fruit, 
tobacco,  and  delicacies.  How  quickly  the  reporters 
sniffed  the  latest  news,  I  learned  in  Porto  Rico.  I 
arrived  from  Arroya  in  the  harbor  of  Ponce,  August 
13.  Rumors  of  peace  were  rife  for  a  number  of  days. 
The  Herald  dispatch  boat,  then  in  the  harbor,  got 
up  steam  at  about  3  o'clock  in  the  afternoon.  Soon 
the  little  craft  put  to  sea,  and  I  watched  its  course  with 
intense  interest.  I  said  to  my  friends,  if  the  boat, 
after  leaving  the  harbor,  turns  in  the  direction  of 
Arroya,  it  means  war;  if  in  an  opposite  direction, 
toward  New  York,  peace  has  been  declared.  The 
proud  little  steamer  turned  its  nose  toward  the  United 


110 

States  and  made  a  bee  line  for  New  York.  It  was  not 
until  the  next  morning  that  the  welcome  news  reached 
headquarters.  This  is  only  one  of  the  many  instances 
in  which  the  reporters  came  in  possession  of  the  latest 
news  before  they  reached  the  officials.  The  rei^orters 
were  also  instrumental  in  exposing  many  irregulari- 
ties and  defects  of  the  military  service  from  head- 
quarters in  Washington  to  the  seat  of  war.  I  have 
no  doubt  that  many  wrongs  were  corrected  under  the 
pressure  of  the  press. 

It  is  not  strange  that  many  of  our  influential  news- 
papers went  a  little  too  far  in  representing  the  griev- 
ances of  the  soldiers  and  in  criticizing  the  action  of  de- 
partments and  officers.  A  tinge  of  sensationalism  is 
common  more  or  less  to  all  of  our  great  dailies.  Inter- 
views that  never  occurred  will  continue  to  appear  as 
long  as  the  reputation  of  a  reporter  depends  largely 
on  his  ability  to  satisfy  the  cravings  of  morbid  curi- 
osity. The  statements  made  to  reporters  are  always 
susceptible  to  more  or  less  reconstruction.  Again,  it 
must  be  remembered  that  some  men  in  the  army,  as 
elsewhere,  are  likely  to  exaggerate  the  true  conditions, 
believing  that  by  doing  so,  their  services  will  be  the 
better  appreciated.  As  the  result  of  my  own  obser- 
vations, I  can  say  without  fear  of  contradiction  that 
the  best  soldiers  do  the  least  grumbling.  The  most 
heroic  and  patriotic  soldiers  have  the  least  to  say  of 
what  they  did  and  in  relating  hairbreadth  escapes.  It 
is  the  drone  that  does  the  complaining,  and  who  rides 
in  ambulances,  and  overcrowds  the  hospital,  and  puz- 
zles and  vexes  the  hard-working  doctor.  To  the 
credit  of  the  armies  of  invasion  I  must  say  that  I 
heard  but  few  complaints  when  the  days  were  darkest 
and  the  food  scantiest.  One  day  I  visited  the  fever 
camp  near  the  division  hospital  of  the  army  before 
Santiago,  where  I  found  two  hundred  patients  liter- 
ally lying  in  the  mud,  with  nothing  but  a  wet  blanket, 
most  of  them  under  a  shelter  tent,  some  of  them  even 
without  this  slight  protection  against  the  pouring 
rains.     Food  was  of  the  plainest   kind,  yet  little  or 


Ill 

no  complaint  here.  The  men  expected  hardships, 
and  when  they  came  they  were  not  disappointed. 
Grumbling  became  more  marked  and  widespread 
with  the  progress  of  the  war,  after  the  men  had  be- 
come worn  out  by  the  campaign,  and  homesickness 
had  gained  a  firm  foothold.  The  severest  complaints 
have  originated  with  camp  followers.  The  Medical 
Department  has  been  criticized  repeatedly,  and  yet 
it  would  be  found  very  difficult  to  find  among  the  re- 
turning soldiers  any  one  who  would  be  willing,  or 
who  would  have  reason  to  complain  of  the  treatment 
he  received  at  the  hands  of  medical  officers.  In 
case  of  war,  the  machinery  of  our  government  is 
a  very  comj^licated  one.  The  executive  power  of 
the  Surgeon-General  is  indeed  an  extremely  limited 
one.  Everything  of  importance  has  to  pass 
through  the  hands  and  by  sanction  of  the  Secretary 
of  War.  The  Secretary  of  War  is  a  busy  man  in  keep- 
ing track  of  what  is  going  in  his  department  outside 
of  the  Surgeon-General's  office.  On  the  other  hand 
the  Medical  Department  depends  entirely  on  the  quar- 
termaster's department  in  forwarding  and  distributing 
medical  supplies.  No  wonder  that  many  collisions 
between  these  departments  occurred  during  the  pres- 
ent war.  Our  experience  has  taught  us  in  a  most 
forcible  way  that  the  Medical  Department  should  have 
charge  of  everything  pertaining  to  the  sick  and 
wounded,  in  order  to  accomplish  that  for  which  it  is 
intended.  The  Secretary  of  War  is  not  supposed  to 
have  any  knowledge  of  medicine  or  surgery  or  other 
wants  of  sick  and  wounded,  and  yet  the  Surgeon- 
General  is  powerless  in  the  execution  of  his  orders 
without  his  co-operation.  If  the  forwarding  and  dis- 
tribution of  the  medical  and  hospital  supplies  were 
directly  under  the  control  and  management  of  the 
Medical  Department  we  would  have  heard  less  of  well- 
founded  complaints  of  the  scarcity  of  medicines  and 
hospital  supplies.  To  make  a  department  strong  and 
efficient  it  must  be  independent.  It  was  not  difficult 
to  foresee  when  this  war  broke  out  that  the  greatest 


112 

danger  the  troops  had  to  expect  was  disease  and  not 
the  Spaniards.  The  importance  of  the  Medical  De- 
partment was  never  more  keenly  apparent  than  at  the 
present  time,  and  yet  what  was  done?  The  highest 
official  in  the  Medical  Department  is  a  Brigadier- 
General,  and  only  five  medical  officers  with  the  rank 
of  Colonel,  and  seven  Lieutenant-Colonels.  For  the 
army  major-generals  were  in  abundance,  brigadier- 
generals  by  the  dozen,  and  colonels  were  turned  out 
by  the  hundreds.  Many  of  the  brigadier-generals  in 
brand  new  uniforms  and  glittering  staffs  never  found 
a  command,  but  their  names  remained  on  the  pay 
roll  just  the  same.  Many  of  our  newly  fledged 
colonels  could  not  handle  a  musket  to  save  their 
lives  and  some  of  them  even  attempted  the  unusual 
feat  of  mounting  the  horse  from  the  right  side.  In 
the  face  of  all  these  appalling  defects  of  army  service 
the  brunt  of  criticism  continues  to  fall  on  the  Sur- 
geon-General  and  his  hard  working  officers  in  the 
field.  Much  has  been  said  of  the  mismanagement  of 
Camp  Wikoff.  Considering  the  limited  transporta- 
tion facilities,  and  the  fact  that  in  less  than  three 
weeks  more  than  3,000  patients  have  been  cared  for, 
it  is  a  source  of  gratification  that  so  much  has  been 
accomplished,  largely  through  the  energy  of  the  Chief 
Surgeon,  Colonel  Forwood,  and  Majors  Brown  and 
Heitzman.  A  corps  of  more  than  one  hundred  female 
nurses,  including  fifty  Sisters  of  Charity,  do  the  nec- 
essary nursing  with  a  will  and  efficiency  that  aston- 
ish the  many  visitors.  The  hospital  tents  go  up  like 
mushroons,  day  after  day,  and  at  the  present  time 
2000  patients  are  well  sheltered  and  well  cared  for. 
No  lack  of  medical  supplies  at  this  time.  The  sur- 
gical ward  in  my  charge  was  completed  today  and  is 
already  crowded  with  patients.  The  liberal  contribu- 
tions sent  here  by  different  relief  societies  supply  the 
sick  and  well  with  an  abundance  of  delicacies  of  all 
kinds.  The  diet  of  the  convalescents  is  luxurious, 
much  better  than  what  is  furnished  by  the  officers' 
mess.     The  Red  Cross  is  doing  excellent  work  here, 


113 

as  elsewhere,  in  the  distribution  of  clothing,  medi- 
cines and  delicacies.  Mrs.  A.  Tscheppe,  who  repre- 
sents a  relief  society  of  New  York,  is  a  familiar  figure 
among  the  soldier  patients  and  has  been  of  much  ser- 
vice in  adding  to  their  comfort  and  speedy  recovery. 
Most  of  the  i^atients  are  suffering  from  malaria, 
typhoid  fever  or  dysentery.  The  number  of  deaths 
average  from  ten  to  fourteen  daily,  a  small  percent- 
age considering  the  number  of  patients  in  the  whole 
camp.  The  patients  here  enjoy  fresh  air,  good  nurs- 
ing and  excellent  treatment,  all  of  which  will  be  con- 
ducive to  rapid  recovery.  The  conditions  here  for 
the  successsul  treatment  of  the  fever  cases  are,  in  my 
opinion,  far  better  than  in  any  of  the  large  hospitals 
in  cities.  It  is  to  be  hoped  that  the  entire  camp  will 
be  vacated  in  from  four  to  five  weeks,  as  after  that 
time  the  soil  will  be  thoroughly  infected,  in  spite  of 
all  precautions,  and  the  indigenous  spread  of  typhoid 
fever  would  follow  as  an  unavoidable  sequence.  The 
surgical  work  consists  in  the  treatment  of  large 
abscesses,  occurring  in  patients  whose  general 
health  has  been  undermined  by  disease,  or  the 
hardships  of  the  campaign,  and  operations  for 
hemorrhoids  and  rectal  fistula.  Unjust  and  unnec- 
essary criticism  has  a  demoralizing  effect  on  those 
directly  or  indirectly  concerned.  It  is  prone  to 
intimidate  and  confuse  those  who  are  criticised 
and  embolden  those  who  look  for  undeserved 
sympathy.  In  this  camp  there  is  no  further 
ground  for  complaint  of  any  kind.  It  is  gen- 
erally known  that  the  Medical  Department  was 
not  consulted  in  locating  the  camps.  For  reasons 
known  only  to  those  in  power,  the  camps  were  selected 
regardless  of  sanitary  conditions.  Our  troops  have 
been  exposed  to  malaria  since  they  left  the  State 
camps,  and  almost  every  man  shows  evidences  of  more 
or  less  malarial  poisoning.  As  the  essential  cause  of 
malaria  enters  the  body  by  inhalation,  malaria  could 
not  be  avoided  as  long  as  the  camps  were  located  on  a 
soil  which  breeds  the  plasmodium.     Typhoid  fever 


114 


made  its  appearance  in  the  State  camps  and  followed 
the  army  to  Chickamauga,  Tampa,  Alger,  Cuba  and 
Porto  Rico.  It  is  a  repetition  of  what  has  happened 
during  all  campaigns  under  similar  circumstances. 
Let  the  national  cry  subside  now  and  let  the  press 
and  people  await  the  results  of  a  thorough  investiga- 
tion by  Congress,  which  will  place  the  responsibility 
for  any  mismanagement  where  it  belongs.  The  Med- 
ical Department  courts  such  investigation,  fully  con- 
fident that  the  blame  will  be  fixed  outside  of  its  legit- 
imate jurisdiction. 

Camp  WikoflF,  Aug.  31,  1898. 


OUR  RELIEF  SOCIETIES. 


War,  pestilence,  famine,  floods  and  other  great 
national  calamities,  are  the  most  reliable  tests  to  bring 
out  the  true  philanthropic  spirit  of  individuals  as  well 
as  of  nations.  The  good  Samaritan  is  to  be  seen  every- 
where under  ordinary  conditions  on  his  errands  of 
mercy,  following  the  footsteps  of  his  Master  in  bring- 
ing comfort  to  the  poor,  the  sick,  the  maimed  and  the 
oppressed,  but  his  energies  are  taxed  to  the  utmost, 
and  his  work  is  appreciated  most  keenly,  when  the 
masses  are  in  distress.  The  American  people  are 
noted  for  their  charitable  disposition,  and  have  gained 
a  well-deserved  reputation  for  humanitarian  work. 
Our  numerous  ideal  charitable  institutions  speak  for 
themselves.  Many  national  catastrophes  have  demon- 
strated the  liberality  and  good-will  of  our  people. 
The  War  of  the  Rebellion  furnished  an  interesting 
object  lesson  to  the  outside  world  of  the  way  in  which 
patriotism  is  estimated  here.  During  the  war  just 
ended  many  diflPerent  relief  societies  have  rivaled  with 
each  other  in  supplying  our  soldiers,  sick  and  well, 
with  many  comforts  of  life  beyond  the  limit  of  the 
government  supplies.  The  government  itself  set  a 
noble  example  by  sending  to  the  camps  and  the  in- 
vading armies  all  kinds  of  supplies,  unparalleled  in 
quantity  and  quality  in  the  history  of  the  country. 
I  am  sure  no  one  regrets  more  keenly  than  the  gov- 
ernment officials  that  these  liberal  supplies  did  not 
always  reach  their  destination  in  time.  The  work  of 
the  many  auxiliaries  corrected  many  of  these  defects. 
Individuals  as  well  as  organized  societies  have  labored 
incessantly  and  faithfully  in  coming  to  the  aid  of  the 
government,  in  furnishing  the  troops  with  under- 
clothing and  delicacies  usually  beyond  the  reach  of 


116 


armies  when  engaged  in  active  warfare.  Miss  Ana- 
bel  Clarestes,  a  little  girl  in  Lagrange,  111.,  has  been 
busy  ever  since  the  war  commenced  in  preparing  and 
sending  to  camps  and  the  front  home-made  jellies, 
the  product  of  her  own  hand.  She  had  no  difficulty 
in  collecting  money  to  purchase  the  necessary  mate- 
rials, but  it  was  left  for  her  to  labor  in  the  humble 
kitchen  to  prepare  the  incomparable  delicacies  for  the 
soldiers  in  the  field.  This  little  American  girl  is  a 
heroine  worthy  of  the  praise  and  admiration  of  the 
returning  heroes  who  have  been  benefited  by  her 
modest,  unselfish  work.  Many  a  patriotic  woman, 
unknown  to  newspaper  notoriety,  has  done  her  share 
in  minimizing  the  sufferings  of  this  war.  It  was  not 
an  uncommon  thing  for  officers  to  receive  a  box  con- 
taining the  contributions  of  some  female  friend  of 
the  army  who  sent  all  she  could  spare  for  the  allevia- 
tion of  the  troops  in  the  field.  In  many  such  instances 
the  name  of  the  benefactress  remained  unknown  to 
those  who  benefited  by  her  donation.  I  have  opened 
many  such  boxes,  containing  as  a  rule  underclothing, 
bandages,  reading  and  writing  material,  towels,  hand- 
kerchiefs, and  a  few  jars  of  jelly  or  canned  fruit.  The 
soldiers  who  were  made  the  recipients  of  these  gifts 
felt  that  they  were  remembered  at  home,  an  assurance 
which  contributed  much  in  intensifying  their  patri- 
otism and  in  sustaining  their  courage  under  the  most 
trying  circumstances.  The  intense  interest  manifested 
by  the  government  and  the  peojDle  in  the  care  and 
comfort  of  the  returning  army  remains  unequaled  in 
the  history  of  our  country.  Every  soldier  was  met 
with  a  reception  given  to  an  intimate  and  long-looked- 
for  friend.  The  sick  received  the  most  tender  care 
from  all  sides,  and  the  well  were  given  food  that  re- 
minded them  that  they  had  reached  home.  The  hos- 
pitals and  many  private  houses  threw  the  doors  wide 
open  to  receive  those  who  required  medical  treatment. 
Transportation  home  was  made  easy  and  comfortable 
by  the  active  intervention  of  thousands  of  friends 
who  were  strangers  when  the  troops  left  for  the  seat 


117 

of  war.  In  all  large  cities  committees  were  organized 
to  look  after  the  comforts  of  the  returning  troops.  In 
short,  it  may  be  safely  stated  that  no  army  ever 
received  a  more  enthusiastic,  kind  and  cordial  recep- 
tion than  the  troops  that  have  reached  us  from  the 
seat  of  war. 

RED    CROSS    SOCIETY. 

Miss  Clara  Barton,  President  of  the  American  Red 
Cross  Society,  has  performed  her  onerous  duties  dur- 
ing the  entire  war  with  a  devotion  and  earnestness 
that  merit  universal  recognition  at  home  and  abroad. 
She  has  been  tireless  in  her  efforts  to  bring  comfort 
to  the  soldiers  at  times  when  her  services  were  most 
needed.  The  Texas  Siud  the  little  steamer  Red  Cross, 
under  her  command,  made  their  appearance  at  Sibo- 
ney  at  a  time  when  outside  help  was  most  appreciated. 
Ice,  medicines,  dressings  and  hospital  supplies  were 
freely  distributed  among  the  sick  and  wounded. 
After  the  surrender  of  Santiago  the  Texas  was  the 
first  vessel  to  enter  its  harbor  on  its  errand  of  mercy 
in  bringing  food  for  the  hungry  Cubans  and  delicacies 
for  the  sick  of  the  victorious  and  vanquished  armies. 
The  Red  Cross  Society  established  supply  depots  in 
all  of  the  large  camps  and  the  good  work  done  every- 
where will  live  in  the  memories  of  all  who  were 
engaged  in  the  conflict.  Miss  Barton  has  the  confi- 
dence of  the  American  people  and  she  has  sustained 
it  through  the  present  war  by  the  thoughtful  and 
timely  distribution  of  the  innumerable  and  liberal 
donations  to  the  society  she  so  well  represents.  An 
appropriate  idea  of  what  this  Society  has  done  can  be 
gained  from  the  fact  that  in  Camp  Wikoff  alone  two 
thousand  dollars  of  supplies  are  distributed  daily. 
Miss  Barton  has  been  assisted  in  her  widespread 
humanitarian  work  by  a  large  staff  of  physicians  and 
nurses  who  came  to  the  relief  of  the  medical  officers 
at  times  when  their  services  were  most  needed.  After 
X3eace  was  declared,  Miss  Clara  Barton  immediately 
sailed  for  Havana  to  bring  much-needed  aid  to  the 
starving    reconcentrados    of    the  long-besieged  city, 


118 

while  her  numerous  helpers  continued  their  faithful 
work  in  the  home  camps.  The  work  of  the  Red 
Cross  received  the  moral  and  substantial  support  of 
the  charitably  disposed  citizens  throughout  the 
United  States  and  liberal  donations  from  abroad. 
Recent  experience  has  again  demonstrated  that  this 
society  is  the  most  important  auxiliary  in  war  as  well 
as  other  natural  disasters  in  bringing  prompt  relief  to 
the  sufferers. 

women's  patriotic  relief  association,  new  YORK. 

This  benevolent  Association  has  extended  its  work 
from  the  camps  to  the  needy  families  of  soldiers  who 
enlisted  and  went  to  the  front,  leaving  families  behind 
them,  worthy  objects  of  well-deserved  charity.  It  was 
founded  in  the  City  of  New  York  at  the  outbreak  of 
the  war,  at  the  residence  of  Mrs.  Egbert  Gurnsey, 
with  Mrs.  Howard  Carroll  as  president  and  well- 
organized  committees  and  ad^  -sory  board,  consisting 
of  prominent  business  and  professional  men.  The 
Association  has  provided  food  and  house  rent,  as  well 
as  medical  attendance,  monthly,  to  no  less  than  2444 
families.  A  free  eatinghouse  was  established  at  711 
Eighth  Avenue,  where  these  families  received  food 
and  clothing.  Mrs.  Charles  Carroll,  a  member  of  the 
Association,  was  made  president  of  the  Naval  Reserve 
Relief,  and  by  contributions  and  a  garden  party  given 
at  her  residence  in  New  Brighton,  Borough  of  Rich- 
mond, the  sum  of  $2500  was  secured,  which  was 
expended  for  the  benefit  of  the  New  York  Naval 
Reserves.  This  special  function  of  the  Association 
did  much  for  the  comfort  and  efficiency  of  this  other- 
wise neglected  branch  of  the  military  service.  The 
hospital  work  of  the  Association  has  been  under  the 
management  of  Mrs.  Charles  Carroll,  Mrs.  Adolph 
Tscheppe  and  Mrs.  Seymore.  The  ladies  of  the 
Association,  with  Mrs.  William  McDonald  as  chair- 
man, gave  an  outing  to  the  convalescent  soldiers 
from  the  different  hospitals  in  Central  Park,  which 
proved  to  be  one  of  the  most  memorable  occasions  in 


119 

the  annals  of  the  history  of  this  famous  park.  Mrs. 
Charles  Carroll  and  Mrs.  Tscheppe  erected  a  tent  in 
Camp  Wikoff  when  the  soldiers  from  Cuba  com- 
menced to  return,  and  have  been  busy  in  distributing 
without  any  red  tape  an  enormous  amount  of  most 
valuable  contributions  among  the  sick  and  convales- 
cents. Their  donations  of  different  stimulants  and 
artificial  waters  have  proved  most  acceptable  and 
timely.  From  this  tent  ice  cream  has  been  furnished 
daily.  A  special  messenger  has  done  excellent  service 
in  distributing  mail  and  in  looking  up  soldiers 
inquired  after  by  anxious  relatives.  80  fertile  have 
been  the  resources  of  this  modest  little  tent  that 
it  has  been  designated  "The  Gold  Mine."  Mrs. 
Tscheppe  represents  the  ladies  of  the  "Liederkranz," 
and  her  popularity  among  the  Germans  of  New  York 
has  brought  not  only  the  most  liberal  donations  but 
likewise  cash  in  large  amounts.  Only  the  other  day 
she  received  from  a  single  source  a  check  for  $500, 
which  she  was  asked  to  use  at  her  own  discretion  in 
the  care  of  the  sick  and  convalescent  in  the  camp. 
The  German  press  of  New  York  has  used  its  influence 
in  supplying  Mrs.  Tscheppe  with  ample  means  on  her 
errands  of  mercy. 

ILLINOIS  ARMY  AND   NAVY  LEAGUE. 

This  relief  association  was  organized  soon  after  war 
was  declared.  It  is  composed  of  representative  men 
and  women  throughout  the  State  of  Illinois,  with  head- 
quarters in  Chicago.  The  secretary.  Dr.  F.  H.  Wines, 
had  an  extensive  experience  in  dispensing  charity 
throughout  the  War  of  the  Rebellion,  and  was  conse- 
quently well  prepared  in  assuming  the  laborious  and 
trying  duties  of  his  office.  While  it  was  the  principal 
intention  of  the  association  to  look  after  the  interests 
and  comforts  of  the  State  Volunteers,  many  of  the 
contributions  reached  soldiers  outside  of  the  Illinois 
troops.  The  State  of  Illinois,  and  the  City  of  Chicago 
in  particular,  have  been  very  activ^e  in  minimizing  the 


120 

inevitable  sufferings  incident  to  active  warfare  by 
sending  to  the  camps  and  the  front  large  quantities 
of  the  most  desirable  articles  of  diet,  delicacies,  under- 
clothing and  medicines.  The  League  made  special 
arrangements  for  transportation  at  reduced  rates,  so 
that  the  donations  reached  their  destination  promptly 
and  at  small  expense.  The  League  has  had  from  the 
very  beginning  a  handsome  bank  account,  and  cash 
was  sent  to  different  points  for  the  purchasing  of  the 
most  necessary  articles.  The  citizens  of  Illinois  will 
have  the  satisfaction  of  showing  that  by  concerted 
action  of  the  members  of  the  League  the  work  of 
charity  and  benevolence  has  been  accomplished  in 
the  most  satisfactory  manner. 

MASSACHUSETTS  VOLUNTEER  AID  ASSOCIATION. 

There  has  been  an  impression  prevailing  among  the 
regular  troops,  that  while  the  soldiers  of  the  regular 
army  have  fought  the  hardest  and  have  been  sub- 
jected to  the  greatest  privations,  they  have  not  re- 
ceived the  recognition  to  which  they  are  entitled,  and 
have  been  more  or  less  ignored  by  the  different  relief 
associations.  There  is  undoubtedly  some  truth  con- 
cerning these  statements.  The  Massachusetts  Vol- 
unteer Aid  Association  has  recognized  the  validity  of 
this  complaint,  and  has  directed  its  surgeons  toward 
correcting  the  oversight.  The  work  of  this  associa- 
tion in  this  direction  has  been  particularly  notable  in 
Camp  Wikoff.  A  number  of  ladies  representing  this 
Association  came  to  the  camp,  and  have  done  all  in 
their  power  to  render  the  soldiers  belonging  to  the 
regular  army  comfortable  and  happy, 

A  light  diet  kitchen  was  established,  provided  and 
equipped  at  the  First  Division  Hospital,  in  charge  of 
Major  Wood,  in  conjunction  with  the  Red  Cross  Soci- 
ety, under  the  superintendency  of  Mrs.  M.  H.  Willard. 
The  kitchen  is  an  ideal  one,  and  is  presided  over  by 
a  competent  chef.  Mrs.  Dininger  is  the  lady  mana- 
ger. The  bountiful  donation  for  the  sick  of  the  Regu- 
lar Infantry  Division  was  brought  to  the  camp  by 


121 

Mrs.  Leach,  wife  of  Major  Smith  S.  Leach,  of  the 
Engineer  Corps  of  the  Regular  Army,  and  was  con- 
tributed by  the  ladies  of  New  London,  Conn.,  and  the 
Pequot  Society.  It  consisted  of  a  well- assorted  col- 
lection of  soups,  eggs,  lemons,  oranges,  butter,  crackers, 
sugar,  barley,  cocoa,  farina,  beef,  ham,  corn- starch, 
codfish,  breakfast  food,  chocolate,  gelatin,  tobacco, 
pipes,  keg  of  whisky,  writing  and  reading  material, 
towels,  j^ajamas,  night- shirts  and  underclothing.  The 
light-diet  kitchen  is  one  of  the  attractions  of  the  camp. 
The  relief  societies  that  I  have  mentioned  are  only  a 
few  of  the  hundreds  organized  throughout  the  United 
States  for  the  same  purpose,  notably  among  them  the 
"Daughters  of  the  Revolution"  and  the  "Colonial 
Dames,"  all  of  which  did  their  good  share  in  allevia- 
ting the  sufferings  of  our  army  in  camp  and  at  the 
front.  The  charity  that  has  been  practiced  so  boun- 
tifully and  so  generally  during  the  present  war,  must 
satisfy  our  victorious  army  that  the  patriotism  they 
carried  into  the  field  has  been  cultivated  at  home  in 
words  and  action  to  a  degree  and  extent  unparalleled 
in  the  history  of  the  world.  War  in  a  just  cause  be- 
gets patriotism,  and  nothing  can  demonstrate  this 
more  clearly  and  forcibly  than  our  experience  in  the 
field  and  at  home  during  the  last  five  months. 

Camp  Wikoflf,  Sept.  8,  1898. 


THE  WOUNDED  OF  THE  PORTO  RICAN 
CAMPAIGN. 


The  Cuban  and  Porto  Rican  invasions  have  con- 
firmed the  experience  of  the  past  in  showing  that  the- 
greatest  horrors  of  war  are  caused  by  disease  and  it& 
consequences  rather  than  the  implements  of  destruc- 
tion. If  the  battle-grounds  are  in  the  extreme  north 
or  south,  climate  enters  as  an  important  factor  in 
decimating  the  ranks  and  in  increasing  the  sufferings 
of  the  contending  armies.  A  war  of  invasion  requires 
more  preparation,  foresight  and  forethought  on  the^ 
part  of  those  who  plan  and  conduct  the  campaign  than 
one  of  defense,  a  fact  we  have  been  painfully  made 
aware  of  during  the  last  two  months.  The  more 
remote  the  seat  of  conflict,  the  more  difficult  the  task 
of  providing  food  and  clothing  for  the  army,  and  the 
more  serious  becomes  the  problem  of  properly  caring 
for  the  sick  and  wounded,  and  the  greater  becomes 
the  difficulty  in  returning  the  survivors  to  their  homes. 
Nostalgia,  a  very  common  affection  among  unseasoned 
troops,  becomes  more  prevalent  in  proportion  to  the 
distance  between  home  and  the  seat  of  war,  as  we  had 
abundant  opportunities  to  observe  during  the  late 
war.  The  depressing  effect  of  this  common  ailment 
has  a  decided  influence  in  increasing  the  rate  of  mor- 
tality of  the  sick  and  wounded,  and  in  impairing  th& 
effectiveness  of  the  fighting  line.  Nostalgia  is  a  con- 
tagious disease,  not  in  the  sense  we  use  the  word 
contagion  ordinarily,  but  when  once  established  in 
camp  it  increases  rapidly  by  suggestion.  The  onset 
and  spread  of  this  common  ailment  of  camp  life  are 
promoted  by  interruptions  of  the  mail  service,  the  only 
medium  of  communication  between  the  soldier  in  the 
field  and  his  distant  home.     Among  the  many  sins  of 


123 

omission  of  those  in  charge  of  the  management  of 
the  late  war  was  a  glaring  neglect  to  provide  for  the 
much-needed  and  anxiously  looked  for  mail  facilities. 
If  those  who  have  the  management  of  this  branch  of 
the  government  service  in  charge  could  be  made  to 
understand  what  an  occasional  letter  will  do  in  keep- 
ing up  the  spirit  of  +he  citizen  soldier,  nostalgia 
would  have  been  less  prevalent  and  its  effects  less 
disastrous  during  the  late  campaign.  From  the  time 
I  left  Fortress  Monroe  for  Cuba,  July  3,  and  until  I 
arrived  in  New  York  from  Porto  Rico,  August  19,  I 
received  only  two  letters  of  the  probable  two  hundred 
sent  to  me  during  this  time.  In  summing  up  the 
casualties  of  the  w^ar  just  ended,  it  is  safe  to  make  the 
statement  that  the  number  of  killed  and  the  number 
of  deaths  resulting  from  the  immediate  effects  of 
wounds  will  not  exceed  280.  The  number  of  wounded 
will  in  all  probability  reach  1425.  The  number  of 
deaths  from  malaria,  dysentery,  yellow  fever  and 
typhoid  can  not  be  estimated  at  this  time,  as  these 
diseases  are  still  prevailing  and  will  claim  many 
victims  before  the  troops  are  recalled.  The  loss 
of  life  and  the  suffering  as  well  as  disability,  as  a 
claim  for  pension,  caused  by  disease  and  the  effects 
of  climate  will  exceed  by  far  those  caused  by  Spanish 
bullets.  During  the  Porto  Rican  campaign  no  pitched 
battle  was  fought.  The  force  of  the  enemy  in  all  of 
the  skirmishes  was  small  and  in  ambush.  Only  a  few 
were  killed  and  not  more  than  forty  were  wounded. 
Among  the  wounded,  bone  injuries  were  rare,  many 
of  the  wounds  slight.  All  of  these  cases  tend  to  con- 
firm previous  observations  to  the  effect  that  the  small 
caliber  bullet  of  the  Mauser  rifle,  the  one  used  exclu- 
sively by  the  Spaniards,  causes  wounds  of  the  soft 
parts,  which  if  left  alone  under  the  first  dressing,  will 
heal  by  primary  intention  in  the  course  of  a  week  or 
two,  unless  complicated  by  serious  visceral  injuries. 
All  of  these  cases  corroborate  the  statement  previously 
made  that  the  small  caliber  bullet  does  not  infect  the 
wound  and  that  it  seldom  carries  with  it  into  the  tis- 


124 

sues  clothing  or  other  infectious  substances.  This 
observation,  so  abundantly  supported  by  substantial 
facts,  is  an  extremely  important  one  for  future  field 
service,  as  it  must  satisfy  the  military  surgeons  that 
such  wounds  will  heal  promptly  if  left  alone  under 
the  first-aid  antiseptic  dressing.  On  the  other  hand, 
I  have  seen  the  evil  consequences  following  meddle- 
some surgery  in  the  form  of  unnecessary  probing. 
Such  wounds  are  very  susceptible  to  secondary  infec- 
tion caused  by  the  use  of  the  probe.  For  the  purpose 
cf  again  calling  attention  to  the  humane  nature  of  the 
modern  weapon,  and  with  a  view  of  showing  how 
rapidly  wounds  inflicted  with  the  small  caliber  bullet 
will  heal  under  the  most  conservative  treatment,  I 
will  report  briefly  the  nature  of  the  wounds  and  the 
results  of  those  wounded  in  the  Porto  Rican  war: 

Case  :?.— Lieut.  J.  C.  Byron,  Troop  F,  Eighth  Cavalry, 
wounded  in  the  skirmish  near  Mayaguez,  August  10.  The 
bullet  passed  through  the  foot  from  side  to  side  on  the  dorsal 
aspect,  making  a  groove  on  the  upper  surface  of  the  second 
and  third  metatarsal  bones  without  fracturing  them.  Healing 
by  primary  intention  under  the  first  dressing.  He  was  in  the 
saddle  when  injured. 

Case  2. — Lieut.  John  Haines,  Battery  F,  Third  Artillery, 
was  wounded  in  the  attack  on  Aibonito,  August  13,  and  is 
probably  the  last  man  shot  by  the  Spaniards  during  the  inva- 
sion of  Porto  Rico.  He  was  in  the  advance  of  the  line,  with 
his  battery  planted  on  a  high  hill  in  full  view  of  the  enemy. 
After  firing  the  number  of  shots  ordered,  the  gun  was  turned, 
and  at  this  moment  a  bullet  struck  him  in  the  left  lumbar 
region,  postaxillary  line,  and  escaped  about  the  sixth  inter- 
costal space,  anterior  axillary  line,  on  the  same  side.  No 
indications  of  bone  injury  or  penetration  of  the  chest.  The 
wounds  were  dressed  in  the  field  and  healed  by  primary  inten- 
tion. He  was  conveyed  in  an  ambulance  from  the  front  to 
Ponce,  a  distance  of  twenty  miles,  and  transferred  to  the  hos- 
pital ship  Relief.  At  no  time  has  he  suffered  much  from  pain 
or  even  a  sense  of  discomfort  which  could  be  referred  to  the 
wound.  The  patient  must  have  been  in  a  stooping  position  the 
moment  the  injury  was  received. 

Case  5.— Lieut.  T.  H.  Hunter,  Battery  B,  Fifth  Artillery, 
was  accidentally  shot  by  one  of  his  own  men  by  a  Krag- Jorg- 
ensen  bullet,  which  entered  the  right  side  of  the  ilium,  passed 
downward  and  backward,  emerging  from  the  gluteal  region  on 
the  same  side  below  the  ramus  of  the  ischium.  The  course  of 
the  bullet  excluded  bone  injury  in  this  case.     Notwithstand- 


125 

ing  the  length  and  depth  of  the  tubular  wound  it  healed 
rapidly  by  primary  intention.  The  indications  are  that  the 
patient  will  recover  without  any  functional  impairment  of  the 
parts  implicated  in  the  injury. 

Case  i.— William  H.  Walcutt,  Company  E,  Fourth  Ohio 
Infantry,  was  wounded  in  the  skirmish  near Guayamo,  August 
8.  The  bullet  entered  the  plantar  surface  of  the  left  foot  be- 
tween the  first  and  second  metatarsal  bones,  at  the  junction  of 
the  middle  with  the  distal  thirds,  and  escaped  from  the  dorsal 
side,  at  a  point  a  little  nearer  the  distal  side.  From  the  course 
of  the  bullet  it  is  clear  that  he  was  running  in  a  direction  op- 
posite to  the  enemy  when  the  shot  was  fired.  The  wounds 
were  healed  a  week  after  the  injury  was  received. 

Case  5. — William  J.  Edgington,  Company  A,  Fourth  Ohio 
Infantry,  was  wounded  during  an  engagement,  August  8.  The 
wound  of  entrance  was  at  a  point  two  inches  to  the  left  of  the 
median  line  on  a  level  with  the  sacrococcygeal  joint,  the 
wound  of  exit  at  the  base  of  the  opposite  thigh  over  its  inner 
and  middle  aspect,  directly  over  the  adductor  muscles.  No 
evidence  of  any  serious  visceral  injury  of  any  of  the  pelvic 
organs.  The  temperature  remained  normal,  the  wounds  healed 
by  primary  intention,  and  when  I  examined  the  patient  in  the 
hospital  at  Guayamo,  five  days  after  the  injury  was  inflicted, 
the  patient  was  free  from  pain  and  able  to  leave  his  cot  with- 
out assistance.  The  course  of  this  bullet  explains  the  position 
of  the  patient  at  the  time  the  bullet  reached  its  unwilling, 
moving  mark. 

Case  0. — Noble  W.  Horlocker,  Company  C,  Fourth  Ohio 
Infantry,  was  wounded  in  the  same  skirmish.  The  bullet  en- 
tered one  inch  in  front  of  the  right  malleolus  and  escaped  two 
and  three-fourth  inches  below  and  a  little  behind  the  external 
malleolus.  Although  the  bullet  must  have  passed  through 
the  ankle  joint  and  the  astragalus,  the  injury  was  followed  by 
very  little  pain,  except  on  moving  the  ankle  joint,  and  no  indi- 
cation of  infection  had  set  in  five  days  after  the  injury  was 
received.  It  is  reasonable  to  expect  that  the  wounds  will  heal 
by  primary  intention,  and  that  the  patient  will  recover  with  a 
useful,  movable  ankle  joint. 

Case  7.— Stewart  J.  Mercer,  Company  E,  Fourth  Ohio 
Infantry,  was  wounded  August  5,  in  a  skirmish  on  the  way 
from  Arroya  to  Guayamo.  The  bullet  made  a  flesh  wound 
over  the  inner  margin  of  the  left  patella,  and  healed  by  pri- 
mary intention  in  a  few  days. 

Case  ^.—Samuel  T.  Jones,  Company  C,  Fourth  Ohio  In- 
fantry, received  a  wound  above  the  right  patella,  August  8. 
Wounds  of  entrance  and  exit  one  inch  apart.  Primary  heal- 
ing under  the  first  dressing. 

Case  9,— Edward  O.  Thompson,  Corporal  Company  K,  Fourth 
Ohio  Infantry,  was  wounded  near  Guayamo,  August  8.  The  bul- 
let entered  the  forearm  two-thirds  of  an  inch  above  the  wrist 


126 


joint,  on  radial  side,  and  after  passing  through  the  soft  tissue 
in  front  of  the  bones,  emerged  from  the  inner  aspect  of  the 
forearm  just  above  the  wrist  joint.  Wound  healed  by  primary 
intention  under  the  first  dressing. 

Case  if),— Harry  Lee  Haynes,  Company  C,  Fourth  Ohio 
Infantry,  was  lying  down  in  a  ditch  at  the  time  he  was 
wounded,  August  8.  The  bullet  struck  the  arm  two  inches 
above  the  insertion  of  the  deltoid  muscle  and  emerged  over 
the  sternoclavicular  articulation  on  the  same  side.  A  third 
wound  was  found  on  a  line  with  the  course  of  the  emerging 
bullet  one  inch  below  the  mastoid  process  and  in  the  direction 
of  the  sterno  cleido-mastoid  muscle.  A  fourth  wound,  an 
inch  and  a  half  in  length,  one- quarter  of  an  inch  in  depth  and 
an  inch  in  width,  was  found  on  the  dorsum  of  the  right  fore- 
arna  an  inch  above  the  elbow  joint.  All  the  wounds  healed 
rapidly,  caused  but  little  suffering,  and  the  patient  was  in  a 
fair  way  to  recovery  when  seen  a  few  days  after  he  was 
wounded. 

Case  iJ.— Clarence  W.  Riffer,  Company  A,  Fourth  Ohio  In- 
fantry, was  wounded  August  8.  The  bullet  entered  the  right 
thigh  at  a  point  five  inches  above  the  knee  joint  and  about  the 
middle  of  the  external  surface,  passed  through  the  soft  tissues 
making  its  exit  three  inches  to  the  left  of  the  point  of  entrance. 
It  re-entered  the  left  thigh  at  a  point  two  and  a  half  inches 
above  the  knee  joint,  and  an  inch  and  a-half  to  the  right  of  the 
posterior  median  line  and  emerged  on  the  oposite  side  an  inch 
and  a-half  above  the  knee  joint.  Both  tlesh  wounds  deep  and 
long  as  they  were  healed  primarily  without  suppuration. 

Case  ii*.— John  O.  Cordner,  Company  C,  Fourth  Ohio  In- 
fantry, was  wounded  August  5.  The  bullet  made  a  flesh 
wound  at  the  lower  border  of  the  patella,  the  wounds  of  en- 
trance and  exit  being  separated  by  a  space  an  inch  and  a  half 
in  length.     Primary  healing  under  first  dressing. 

Case  J5.— William  Rossiter,  Company  G,  Eleventh  U.  S.  In- 
fantry, was  wounded  in  the  skirmish  near  Mayaguez,  August 
10.  He  was  shot  through  the  inferior  maxilla.  The  bullet 
entered  just  below  the  margin  of  the  bone  on  the  right  side 
about  an  inch  in  front  of  the  angle  and  emerged  over  the  angle 
of  the  bone  on  the  opposite  side,  perforating  the  soft  tissues  of 
the  neck  in  a  transverse  direction.  The  bullet  appears  to  have 
passed  through  the  bone  without  fracturing  it.  The  only  pain 
the  patient  complains  of  is  produced  when  he  undertakes  to 
masticate  food.  Wounds  of  entrance  and  exit  healed  in  a  few 
days  by  primary  intention. 

Case  14. — Amos  Wilkie,  Eleventh  U.  S.  Infantry,  was  on  the 
march  when  wounded  near  Mayaguez,  August  10.  The  bullet 
entered  the  right  lumbar  region  just  above  the  crest  of  the 
ilium,  mid  axillary  line,  and  emerged  about  two  inches  to  the 
left  of  the  spine  and  four  inches  above  the  left  sacro-iliac  syn- 
chondrosis.    No  indications  of  intra-abdominal  complications. 


.    127 

He  suffered  considerable  from  cramping  pains,  which  he  attri- 
butes to  cold  and  fever  which  he  contracted  by  exposure  to 
rain.  A  week  after  the  injury  was  received,  when  the  patient 
was  an  inmate  of  the  Hospital  Ship  Relief,  his  condition  war- 
ranted the  hope  of  an  early  and  complete  recovery. 

Cane  ir>. — Harry  C.  Errick,  Company  C,  Eleventh  U.  S.  In- 
fantry, was  wounded  August  10,  in  a  charge  on  the  enemy  in 
ambush.  Wound  of  entrance  in  left  leg  over  the  outer  aspect 
of  the  .middle  third  ;  the  bullet  passed  downward  and  inward 
and  emerged  about  five  inches  above  the  inner  malleolus. 
Hemorrhage  slight,  no  fracture.  Wound  healing  rapidly  under 
first  dressing. 

Case  16. — William  H.  Wheeler,  Company  A,  Eleventh  U.  S. 
Infantry,  was  wounded  August  10,  near  Mayaguez,  when  in  a 
standing  position  with  his  side  in  the  direction  of  the  enemy, 
his  gun  down,  ready  to  reload.  The  bullet  struck  the  tenth 
intercostal  space,  leftside,  in  the  post  axillary  line  and  made 
its  exit  about  four  inches  from  the  spine  in  the  lumbar  region 
close  to  the  margin  of  the  last  rib.  No  serious  complications 
followed  the  injury,  and  at  the  present  time,  August  14,  the 
patient  is  improving  rapidly. 

Case  11. — George  Curtis,  Company  D,  Light  Battery,  Fifth 
Artillery,  received  a  wound  of  the  chest  August  10,  being  in  his 
saddle  at  the  time.  The  bullet  passed  through  the  chest  from 
the  second  left  intercostal  space  in  front  to  the  middle  of  the 
outer  border  of  the  scapula  on  the  same  side.  No  hemoptysis 
or  any  other  serious  symptoms  indicating  the  existence  of  the 
visceral  wound  of  the  lung.  The  only  thing  he  complains  of  is 
a  sense  of  numbness  in  the  left  arm.  Primary  union  of  both 
wounds. 

Case  i8.— Joseph  P.  Ryan,  Corporal  Company  A,  Eleventh 
U.  S.  Infantry,  was  wounded  August  10.  The  bullet  passed 
through  the  ankle  joint.  Wound  of  entrance  over  the  internal 
malleolus  of  left  leg,  wound  of  exit  two  inches  below  the  outer 
malleolus.  No  infection  or  signs  of  synovitis.  Wounds  heal- 
ing by  primary  intention. 

Case  19. — Samuel  Copp,  Company  A,  Eleventh  U.  S.  In- 
fantry, received  a  scalp  wound,  August  10,  while  he  was  lying 
on  his  abdomen  on  the  summit  of  a  hill.  Wounds  of  entrance 
and  exit  about  two  inches  apart,  healed  under  the  first  dressing. 
He  is  suffering  from  a  contusion  of  his  abdomen  he  sustained 
by  falling  over  an  embankment  during  the  same  skirmish. 

Case  20. — Arthur  Sparks,  Company  C,  Eleventh  U.  S.  In- 
fantry, received  a  wound  of  the  lower  third  of  the  left  thigh, 
August  10.  Wound  of  entrance  on  external  anterior  aspect  of 
thigh  about  five  inches  above  patella.  The  bullet  passed 
directly  backward  and  came  out  on  the  opposite  side  on  the 
same  level  without  injuring  the  femur.  Healing  by  primary 
intention. 

Case  21. — George  W.  Whitlock,  Company  C,  Sixteenth  Penn- 


128 


sylvania  Infantry,  was  in  a  kneeling  position  when  wounded 
near  Guayamo,  August  9.  The  bullet  entered  the  thigh  near 
the  perineum,  over  the  adductor  magnus  muscle,  passed  in 
an  outward  and  backward  course  and  emerged  from  the  gluteal 
region  near  or  over  the  sciatic  foramen.  Hemorrhage  slight. 
Paralysis  of  the  foot  and  lower  part  of  the  leg  points  to  injury 
of  the  sciatic  nerve.     Healing  of  wound  without  complications. 

Case  2^. —James  Drummond,  Company  K,  Sixteenth  Massa- 
chusetts Infantry,  was  wounded  near  Guayamo,  August  9. 
The  bullet  entered  the  neck  on  the  leftside,  behind  the  sterno- 
cleido- mastoid  muscle,  two  inches  below  the  mastoid  process. 
Wound  of  exit  on  the  opposite  side  in  front  of  the  trapezius 
muscle.  No  immediate  or  remote  complications.  Wound  healed 
by  primary  intention.  Patient  has  suffered  from  slight  attack 
of  malarial  fever. 

Case  25.— Paul  J.  Mytzkie,  Company  D,  Eleventh  U.  S. 
Infantry,  was  wounded  in  the  skirmish  near  Mayaguez,  August 
10.  The  bullet  made  a  flesh  wound  three  inches  above  the 
external  malleolus,  which  healed  in  a  few  days  by  primary 
intention  under  the  first  dressing. 

Case  24. — Daniel  J.  Graves,  Company  M,  Eleventh  U.  S. 
Infantry,  received  a  gunshot  wound  of  the  thigh  near  Maya- 
guez, August  10.  The  bullet  passed  through  the  thigh  in  an 
antero  posterior  direction,  fracturing  the  femur  at  the  junction 
of  the  middle  with  the  lower  third.  A  week  after  the  injury 
the  patient  was  in  excellent  condition,  the  wounds  remaining 
aseptic  and  healing  rapidly. 

Case  25. — Theodore  H.  Newbold,  Company  I,  Sixteenth 
Pennsylvania  Infantry,  was  shot  while  retreating  during  the 
skirmish  near  Guayamo,  August  9.  The  bullet  entered  the 
right  arm  above  the  olecranon  process  and  emerged  from  the 
extensor  side  of  the  forearm  between  the  radius  and  the  ulna. 
The  olecranon  process  was  broken  off.  The  X-ray  reveals  the 
presence  of  a  fragment  of  the  bullet,  or  its  mantel,  lodged  in 
the  wound.     Aseptic  healing  of  the  wound. 

Case  26.— Clyde  C.  Prank,  Company  C,  Sixteenth  Pennsyl- 
vania Infantry,  was  injured  near  Guayamo,  August  9.  The 
bullet  entered  the  inner  surface  of  the  middle  of  the  right 
thigh,  passed  upward  and  backward,  and  in  grazing  the  femur 
made  a  groove  without  fracturing  the  bone,  emerging  from  the 
external  and  posterior  aspect  of  the  thigh.  Both  wounds 
healed  by  primary  intention.  In  making  a  skiagraphic  examin- 
ation of  the  seat  of  injury  a  fragment  of  the  bullet  was  dis- 
covered in  the  groove.  The  piece  of  lead,  as  well  as  a  few  loose 
fragments  of  bone,  were  removed  August  17  by  enlarging  the 
wounds  of  entrance  and  exit.     Operation  by  Dr.  Shultze. 

Case  27.— John  L.  Johnson,  Company  D,  Eleventh  U.  S. 
Infantry,  received  a  gunshot  injury  near  Mayaguez,  August  10. 
The  bullet  passed  in  an  antero  posterior  direction  through  the 
middle  third  of  the  left  leg,  going  through. the  space  between 


129 


the  tibia  and  fibula.  Hemorrhage  slight.  Healing  by  primary 
intention. 

Case  28. — Samuel  G.  Prye,  Company  D,  Fifth  Artillery,  was 
injured  by  a  deflected  bullet,  as  he  stood  by  his  cannon,  near 
Mayaguez,  August  10.  The  bullet  passed  through  the  soft 
tissues  in  the  right  anterior  axillary  fold  without  doing  any 
further  damage.     The  wound  healed  by  primary  intention. 

Case  29. — Henry  Gerrick,  Company  E,  Eleventh  U.  S.  Infan- 
try, received  a  superficial  wound  over  the  pronator  muscles, 
near  Mayaguez,  August  10.  The  wound  healed  promptly  by 
granulation. 

Case  30. — John  Browning,  Corporal,  Battery  D,  Fifth  Artil- 
lery, was  wounded  near  Mayaguez,  August  10.  The  bullet 
passed  transversely  through  the  soft  tissues  of  the  right  fore- 
arm on  a  level  with  the  wrist,  in  front  of  the  radius  and  ulna. 
The  bullet  evidently  cut  the  ulnar  nerve  and  vein,  as  shown  by 
the  paralysis  of  the  parts  supplied  by  the  nerve  below  the  seat 
of  the  wound  and  the  free  venous  hemorrhage  which  immedi- 
ately followed  the  injury.     Healing  by  primary  intention. 

Th§  marked  contrast  in  the  results  of  the  treatment 
of  the  wounded  in  Cuba  and  Porto  Rico,  I  attribute 
entirely  to  the  better  preparations  made  for  the  last 
invasion,  and  not  to  any  difference  in  the  surgical 
skill  of  the  medical  officers.  The  surgeons  engaged 
in  the  Cuban  war  were  men  exceptionally  well  pre- 
pared for  their  profession,  and  performed  their  oner- 
ous task  with  energy  and  enthusiasm.  Ambulances 
were  scarce,  the  fighting  line  far  away  from  the  base 
hospital,  conditions  which  made  it  difficult  to  render 
timely  and  efficient  first  aid.  Another  circumstance 
which  had  its  influence  in  interfering  with  the  prompt 
and  effective  first  aid  to  the  wounded  in  Cuba  was 
the  large  number  of  men  who  fell  in  battle  in  three 
days.  The  war  in  Cuba  precipitated  in  a  pitched 
battle;  in  Porto  Rico  it  consisted  in  a  number  of  skir- 
mishes in  which  only  a  small  number  needed  surgical 
attention.  In  Porto  Rico  the  rear  of  the  different 
armies  was  supplied  with  an  adequate  number  of 
ambulances  and  Hospital  Corps  men.  The  first  aid 
was  rendered  almost  immediately  after  the  wounds 
were  received,  after  which  the  patients  were  conveyed 
to  the  hospital  at  once.  A  sufficient  number  of  med- 
ical officers  were  on  hand  during  each  engagement  to 


130 

take  immediate  and  proper  care  of  the  wounded.  In 
most  instances  the  wounds  healed  by  primary  inten- 
tion under  the  first  dressing.  The  value  and  impor- 
tance of  early  surgical  attention,  and  the  first-aid 
dressing,  became  apparent  in  comparing  the  condition 
of  the  wounds,  a  week  after  the  injuries  were  received, 
during  the  Cuban  and  Porto  Rican  campaigns. 


ON  THE  FREQUENCY  OF  CRYPTORCHISM  AND 
ITS  RESULTS. 


Cryptorchism  and  incomplete  descent  of  the  testicle  are 
congenital  defects,  the  frequency  of  which  has  never  been 
established  by  reliable  and  extensive  statistics.  Undescended 
testicle,  partial  and  complete,  is  frequently  seen  in  infants 
and  children,  but  becomes  more  rare  with  the  development  of 
the  body  to  manhood.  The  writer  has  recently  had  an  oppor- 
tunity to  make  an  accurate  investigation  into  this  subject  by 
the  examination  of  9B15  recruits  for  the  Volunteer  Service  at 
Camp  Tanner,  Springfield,  111.  The  ages  of  the  men  varied 
from  16  to  51.  The  following  is  the  result  of  the  examination 
with  reference  to  the  incomplete  descent  of  the  testicle  : 

Cry2)torchis7n.— Right  side,  12;  leftside,  22;  both  sides,  1. 

Incomplete  descent  of  testicle.— Right  side,  10  ;  with  hernia, 
1 ;  left  side,  14. 

Total  number  of  incomplete  descent  of  the  testicle  in  9815 
men,  59.  Unilateral  incomplete  descent,  the  left  side  was 
affected  36  times,  the  right  side  22.  Out  of  59  cases  the 
defect  was  bilateral  only  once.  In  this  case  the  inguinal  canals 
were  found  completely  obliterated,  no  trace  of  the  testicle 
could  be  found.  The  man  was  in  excellent  health,  married  and 
father  of  several  children.  In  only  two  instances  was  the 
incomplete  descent  of  the  organ  complicated  by  a  small  hernia, 
in  both  cases  on  the  right  side.  Both  of  these  men  were 
rejected.  In  all  cases  in  which  the  testicle  could  be  palpated 
the  organ  was  found  atrophic,  seldom  exceeding  the  size  of  a 
filbert  or  pigeon's  egg,  soft  and  not  tender  to  touch.  The 
testicles  were  most  frequently  found  just  within  or  below  the 
external  inguinal  ring  ;  in  the  latter  location  it  could  be  freely 
moved  in  all  directions  without  causing  any  pain.  None  of  the 
men  thus  afflicted  complained  of  pain  or  even  discomfort 
caused  by  the  imperfectly  developed  and  incompletely  de- 
scended testicle.     Recent  scientific   investigations  appear  to 


132 


establish  the  fact  that  cryptorchism  and  incomplete  descent  of 
the  testicle  are  attributed  rather  to  an  imperfect  development 
of  the  organ  than  to  a  failure  to  reach  its  normal  destination 
at  the  right  time.  The  results  of  these  researches  as  well  as 
the  deductions  to  be  drawn  from  statistic  material  utilized  in 
this  paper  seem  to  combine  in  teaching  surgeons  caution  in 
undertaking  early  operations  for  cryptorchism  for  the  purpose 
of  transplanting  the  organ  into  its  normal  position  and  with  a 
view  of  maintaining  or  increasing  its  functional  activity.  The 
congenital  hernia  which  so  constantly  attends  retarded  descent 
of  the  testicle  frequently  disappears  in  the  course  of  time 
without  operative  or  truss  pressure. 
Chickamauga,  June  25,  1898. 


THE  SEAT  OF  WAR  AND  OUR  MILITARY 
SURGEONS. 


At  the  time  I  am  writing  this  communication  I  am  at  Fort- 
ress Monroe  awaiting  the  arrival  of  the  battleship  Yale  from 
Santiago  de  Cuba.  Waiting  is  always  tiresome,  tedious,  and 
often  painful,  but  when  it  comes  to  waiting  for  a  ship  to  take 
you  to  the  seat  of  war,  it  is  distressing.  It  has  been  the  dream 
of  my  youth  to  take  an  active  part  in  some  great  war,  and  now 
that  I  am  in  one,  the  very  thought  that  I  might  not  get  near 
the  fighting  line  is  a  source  of  keen  disappointment.  I  have 
been  in  hopes  that  I  would  be  present  during  the  siege  of  San- 
tiago de  Cuba,  but  according  to  the  messages  that  are  being 
flashed  (July  2)  from  the  seat  of  war  to  the  department  in 
Washington,  the  stars  and  stripes  will  float  over  the  doomed 
city  in  less  than  twenty-four  hours.  The  Yale  is  expected  to- 
day, but  it  will  take  at  least  two  or  three  days  for  the  troops 
to  embark. 

Our  victories  on  land  and  sea  will  teach  the  crumbling  mon- 
archies of  the  old  world  that  the  American  people  are  not 
only  foremost  in  agriculture,  commerce  and  the  different  in- 
dustries, but  that  when  forced  to  fight  they  know  how  to  con- 
duct a  war.  The  heroic  deeds  of  the  American  soldier  have  never 
been  appreciated,  except  by  those  who  were  the  means  of  giv- 
ing him  an  opportunity  of  demonstrating  his  military  quali- 
ties. England,  Mexico  and  the  native  Indians,  have  been 
made  to  feel  and  are  satisfied  what  the  American  soldiery  can 
do.  The  proud  Spaniards  will  be  humuiliated  in  the  eyes  of 
the  world  as  never  before,  and  will  soon  plead  for  mercy  and 
raise  the  white  flag  to  negotiate  for  peace  on  any  terms.  Our 
people  are  now  giving  the  world  an  object  lesson  in  warfare 
that  will  not  surely  be  forgotten.  The  military  spirit  is  epi- 
demic in  our  country  ;  kindle  it  and  it  spreads  like  a  flash  of 
lightning,  from  North  to  South  and  East  to  West.  We  have 
the  men,  the  muscle  and  the  brains  to  bring  into  the  field,  at 


134 

short  notice,  the  best  army  in  the  world.  Only  sixty-five  days 
have  elapsed  since  the  Chief  Executive  of  the  United  States 
issued  the  first  call  for  troops,  and  at  the  present  time  a  fairly 
well  equipped  army  of  200,000  men  are  in  the  field,  eager  and 
anxious  to  face  the  enemy.  Our  navy,  the  laughing-stock  of 
haughty  foreign  countries,  has  grown  with  an  astounding 
rapidity,  and  its  achievements  have  already  challenged  the 
admiration  of  the  world,  and  have  become  a  source  of  pride  to 
every  loyal  American  citizen.  Statesman  and  politicians  may 
differ  in  their  views  regarding  the  propriety  and  advisability 
of  extending  our  possessions  beyond  the  present  limits,  but 
one  thing  remains  sure,  that  our  country — perhaps,  less  as  mat- 
ter of  choice  than  of  necessity — is  destined  to  take  an  active 
part  in  the  drama  of  international  politics.  The  annexation 
of  Hawaii  and  the  present  war  with  Spain — the  latter  provoked 
upon  the  most  unselfish  and  purely  humanitarian  motives — 
have  furnished  the  entering  wedge  into  the  field  of  foreign 
politics.  Cuba  should  and  must  be  owned  by  the  United 
States.  Cuba  is  the  hot-bed,  the  breeding  station  of  yellow 
fever,  and  always  will  remain  so,  whether  under  Spanish  or 
Cuban  rule.  Yellow  fever  can  be  stamped  out  forever  in  less 
than  two  years  after  it  has  come  into  our  possession.  Yellow 
fever,  always  imported  from  Cuba,  has  retarded  the  prosperity 
of  the  South,  and  has  ruined,  at  different  times,  the  commerce 
of  many  of  its  otherwise  flourishing  cities,  and  has  claimed 
the  lives  of  more  of  our  people  than  will  be  sacrificed  in  wip- 
ing out  Spanish  rule.  Geographically  and  commercially,  Cuba 
belongs  to  the  United  States.  Cuban  government  would  be 
only  a  repetition  of  what  has  always  been  going  on  in  the 
neighboring  islands  and  the  republics  of  Central  America- 
misrule  and  revolution.  We  want  no  such  neighbors.  Cuba 
must  be  freed  from  the  Spanish  yoke.  The  Cubans  are  not  in 
a  condition  to  establish  and  maintain  a  wise  and  prosperous 
self-government.  Any  such  attempt  would  be  little  or  no  im- 
provement over  Spanish  rule,  either  to  its  population  or  the 
people  of  the  United  States.  The  natural  resources  of  the 
island  are  great,  and  are  only  awaiting  a  stable  government 
for  their  development.  The  scourge  of  yellow  fever,  always  a 
menace  to  the  life  and  commerce  of  our  people,  more  especially 
of  the  Southern  States,  must  be  quickly  and  permanently  re- 


135 


moved  by  effective  sanitary  measures,  which  can  only  be  effi- 
ciently carried  into  effect  by  placing  the  island  under  the  con- 
trol of  the  government  of  the  United  States. 

OUR  MILITARY  SURGEONS. 

The  medical  profession  of  all  countries  has  always  been 
intensely  patriotic  in  times  of  war.  The  doctors  always  have 
been  and  always  will  be  the  salt  of  the  population.  Their 
education  and  training  are  of  a  nature  to  ensure  qualities 
necessary  to  citizenship  of  the  highest  type.  The  practice  of 
their  profession,  even  in  times  of  peace,  is  admirably  adapted 
to  prepare  them  for  the  emergencies  of  war.  In  the  exercise  of 
their  duties  they  encounter  hardships  and  dangers  foreign  to 
the  lives  of  the  average  citizens.  They  face  epidemics  far 
worse  than  bullets,  as  far  as  danger  to  life  is  concerned,  with- 
out fear  of  death.  In  cities  devastated  by  the  scourge  of 
yellow  fever  or  cholera,  when  everybody  else  that  can  leaves 
for  a  place  of  safety,  the  doctors  remain  at  their  posts  and 
minister  to  the  sick  and  dying  without  any  expectation  of  a 
substantial  financial  reward,  or  even  the  gratitude  of  the 
recipients  of  their  services.  As  the  number  of  their  well-to-do 
legitimate  clients  diminishes  during  the  inevitable  exodus  their 
attention  to  the  poor  remains  unremitting.  Day  after  day  and 
night  after  night  the  familiar  modest  conveyance  with  its 
lonely  occupant  can  be  seen  in  the  depopulated  streets,  wend- 
ing its  way  to  the  hovels  of  the  poor  on  its  errands  of  mercy. 
The  unselfish  work  of  the  doctor  has  never  been  properly 
appreciated.  From  the  most  ancient  times,  when  battles  were 
fought  hand  to  hand  with  the  most  primitive  weapons,  medical 
men  were  on  hand  ready  to  dress  the  wounded  and  to  heal  the 
sick.  None  of  them  have  ever  attained  the  fame  of  the  innu- 
merable heroes  who  distinguished  themselves  on  the  battle- 
field and  whose  deeds  have  been  immortalized  in  prose  and 
poetry.  In  rank,  pay  and  social  position  the  military  surgeon 
has  always  been  at  a  disadvantage  as  compared  with  the  lead- 
ers of  troops.  The  one  that  knows  how  to  kill  and  mutilate 
has  reaped  more  credit  for  his  work  than  the  one  bent  on  his 
sole  mission  to  prevent  and  treat  disease  and  to  heal  wounds. 
Fame,  influence  and  public  recognition  are  within  easy  reach 
of  the  successful  military  commander  ;  they  need  not  be  looked 


136 


for,  much  less  expected,  by  the  hard-working,  faithful,  skilful 
surgeon.  His  greatest  reward,  in  military  or  civil  practice, 
always  has  been  and  always  will  be  the  consciousness  of  having 
performed  his  duty  to  his  fellow-men. 

During  the  present  war  with  Spain  the  medical  profession 
has  responded  promptly  and  nobly  to  the  call  of  the  country. 
The  medical  officers  now  in  the  field  can  be  classified  as  fol- 
lows :  Surgeons  and  assistant-surgeons  United  States  Army ; 
surgeons  and  assistant  surgeons  United  States  Navy;  sur- 
geons and  assistant  surgeons  of  Volunteers;  acting  assistant- 
surgeons  United  States  Army ;  acting  assistant-surgeons  of 
United  States  Navy.  The  surgeons  of  the  army  and  navy, 
after  a  long,  comparative  rest,  have  now  found  an  opportunity 
to  make  good  use  of  their  special  training.  Many  of  these 
men  have  taken  a  course  in  the  Army  Medical  School  and 
most  of  them  have  enjoyed  excellent  clinical  opportunities 
in  the  large  cities.  Surgeon-General  Sternberg  has  taken 
special  pains  to  stimulate  the  younger  members  of  his 
department  to  improve  themselves  by  stationing  them  for 
a  year  in  medical  centers,  where  they  had  an  opportunity 
to  attend  lectures  and  clinics  and  to  do  laboratory  work.  The 
advantages  of  instruction  of  this  kind  will  become  obvious 
in  this  war.  The  professional  military  surgeon  is  well  versed 
in  the  executive  part  of  his  duties,  which  is  sadly  lacking  in 
the  less  favored  volunteer  surgeon.  To  the  praise  of  the  former 
it  must  be  said  that  he  is  always  ready  to  impart  knowledge  of 
this  kind  to  his  colleague  from  civil  life.  The  volunteer  sur- 
geon represents  that  portion  of  the  young  men  of  our  profession 
who  possess  not  only  a  full  measure  of  patriotism,  but  also  a 
laudable  degree  of  surgery  and  enthusiasm.  Many  of  them 
now  in  the  field  have  left  a  lucrative  practice,  and  are  now 
giving  their  services  to  the  country  for  an  insignificant  salary. 
Many  of  our  volunteer  surgeons  have  had  hospital  experience 
either  as  internes  or  attending  physicians,  or  both.  Their  prac- 
tical experience  has  been  such  as  to  prepare  them  well  for  their 
work  in  the  field.  Without  exception  all  are  anxious  to  go  to 
the  front  to  assume  the  hardships  of  active  military  life.  They 
are  anxious  and  ready  to  learn  and  work.  The  only  complaints 
I  have  heard  were  about  the  monotony  and  nothing- to-do  of 
camp  life.     Every  one  that  goes  to  the  front  is  envied  by  those 


137 

left  behind.  They  have  left  their  homes,  their  families,  their 
practice,  to  sacrifice  themselves,  if  need  be,  for  the  good  cause. 
I  am  sure  when  the  Medical  and  Surgical  History  of  the  Amer- 
ican Spanish  War  is  written  it  will  be  brim  full  of  the  good 
work  done  by  the  volunteer  surgeons.  It  will  record  at  the 
same  time  many  deeds  of  bravery  and  heroism  on  their  part. 
The  acting  assistant-surgeons,  both  in  the  Array  and  the  Navy, 
are  so-called  contract  surgeons.  They  are  appointed,  without 
examination,  by  the  respective  Surgeon-Generals,  for  the  dura- 
tion of  the  war,  and  are  given  the  rank  and  pay  of  a  first  lieu- 
tenant. They  are  mostly  bright  young  men,  recently  from  col- 
lege or  hospital,  who  will  do  their  good  share  in  preventing 
disease  and  in  relieving  the  sufferings  of  the  sick  and  wounded. 
The  Association  of  Military  Surgeons  of  the  United  States  has 
done  the  most  during  its  short  existence  of  eight  years  in  es- 
tablishing the  most  friendly  relations  between  the  professional 
and  civilian  military  surgeons,  and  in  preparing  the  medical 
service  for  war.  The  interest  in  this  association  will  be  greatly 
enhanced  by  the  present  war,  and  the  first  meeting  after  the 
close  of  hostilities  will  be  a  large  and  enthusiastic  one. 

As  I  write,  an  order  reaches  me  from  Washington  instruct- 
ing me  to  be  in  readiness  to  leave  this  evening  or  tomorrow 
morning  on  the  hospital  ship  Relief,  which  calls  here  on  its 
way  from  New  York  to  Santiago.  Acting  Assistant- Surgeon, 
Henry  S.  Greenleaf,  son  of  the  Chief  Surgeon  of  the  Army  in 
the  field,  accompanies  me,  and  will  be  associated  with  me  in 

my  future  work. 

Fortress  Monroe,  July  2,  1898. 


Headquarters  Fifth  Army  Corps, 
Before  Santiac40,  July  12,  1898. 

As  the  hospital  ship  Relief  came  in  sight  of  the  seat  of  war 
every  one  of  its  passengers  watched  with  interest  and  anxiety 
the  indications  of  the  present  status  of  the  conflict.  When  we 
sailed  from  Fortress  Monroe,  Sunday,  July  3,  fighting  was  in 
progress,  and  not  having  received  information  of  any  kind 
since  that  time  we  were  impatient  for  news.  On  reaching 
Guantanamo  we  came  in  sight  of  a  number  of  warships  floating 
lazily  on  the  placid  ocean,  like  silent  sentinels,  some  six  to 
eight  miles  from  the  shore.  The  little  bay  was  crowded  with 
empty  transports,  all  of  which  indicated  that  we  were  not  as 
yet  in  possession  of  Santiago.  The  pilot  of  a  patrol  boat  finally, 
in  a  voice  like  that  of  a  fog  horn,  communicated  to  us  the  news 
that  the  greater  part  of  the  Spanish  fleet  had  been  destroyed 
and  that  the  Spanish  loss  in  dead,  wounded  and  prisoners  was 
great.  Among  the  most  important  prizes  of  the  naval  battle 
was  the  heroic  admiral  of  the  Spanish  fleet,  who  was  then  a 
prisoner  on  board  of  one  of  the  men-of-war.  The  land  forces 
were  near  the  city  making  preparations  for  the  final  attack. 
A  partial,  if  not  a  complete  victory  had  been  won,  and  we  had 
the  satisfaction  of  knowing  that  we  had  not  come  in  vain.  Our 
captain  was  directed  to  bring  his  ship  to  anchor  near  Siboney. 
When  we  came  in  sight  of  this  little  mining  town  we  saw  on 
shore  rows  of  tents,  over  which  floated  the  red  cross  flag,  show- 
ing us  that  we  had  reached  the  place  for  which  we  had  been 
intended.  The  little  engine  of  a  narrow-gauge  mining  railroad 
was  puffing  and  screeching  up  and  down  along  the  coast  con- 
veying supplies  .from  the  landing  to  the  camp.  On  the  side  of 
a  hill  were  the  shelter  tents  of  a  company  of  infantry  on  detail 
for  guard  duty.  On  the  crest  of  a  number  of  high  hills  which 
fringe  the  coast  could  be  seen  block-houses  recently  vacated 
by  the  Spaniards.  A  grove  of  palm  trees  in  a  near  valley  re- 
minded us  that  we  had  reached  the  tropical  climate.     The 


139 

steamer  Olivette,  floating  the  Red  Cross,  was  anchored  near  the 
shore.  Major  Appel,  surgeon  in  charge  of  this  hospital  ship 
was  the  first  person  to  board  our  vessel,  and  gave  us  the  first 
reliable  account  of  the  recent  battle.  His  appearance  was 
enough  to  give  us  an  insight  into  his  experience  of  the  last  few 
days.  He  was  worn  out  by  hard  work  and  his  anxiety  for  the 
many  wounded  under  his  charge.  He  spoke  in  the  most  flat- 
tering terms  of  the  services  of  Acting  Assistant-Surgeon 
Parker  of  New  Orleans.  Owing  to  the  depth  of  the  ocean,  it 
was  impossible  to  find  anchorage  for  the  Relief  on  the  first  day. 
The  sea  was  quite  rough  and  it  was  under  difRculties  that 
Majors  Torney,  Appel  and  the  writer  were  landed  on  July  7. 
The  first  person  I  met  on  landing  was  Major  Nancrede,  pro- 
fessor of  surgery  in  the  University  of  Michigan,  He  reached 
Cuba  at  the  right  time  to  give  his  valuable  services  to  his 
country.  Hundreds  of  wounded  had  received  the  benefit  of 
his  skill.  Slight  in  figure,  and  anything  but  robust,  he  per- 
sisted in  working  night  and  day,  until  he  was  worn  out  by 
fatigue  and  loss  of  sleep.  I  found  him  under  a  fly-tent,  resting 
on  the  hot  sand.  He  was  making  preparations  for  an  early 
departure,  in  charge  of  301  wounded,  on  the  transport  ship 
City  of  Washington.  The  country,  and  especially  those  who 
received  his  careful  attention,  owe  a  debt  of  gratitude  to  Major 
Nancrede  that  can  never  be  paid. 

On  reaching  the  camp  I  met  my  friend  of  years  ago,  Major 
LaGarde,  U.  S.  A.,  in  charge  of  the  hospital  at  Siboney,  which 
had  been  made  the  base  of  operations  of  the  troops  in  the  field. 
It  would  have  been  difficult  indeed  to  find  a  better  man  for 
this  trying  and  responsible  position.  By  nature  and  training 
a  perfect  gentleman,  learned  in  his  profession  and  experienced 
in  warfare,  he  was  in  possession  of  all  the  qualities  required  of 
a  medical  officer  in  charge  of  such  an  important  post.  The 
difficulties  he  encountered  often  appeared  insurmountable,  but 
were  met  successfully  by  his  cool  and  mature  judgment  and 
promptness  of  action.  His  kind  but  dignified  conduct  com- 
manded the  respect  of  his  subordinates,  who  were  only  too 
willing  to  carry  out  his  orders.  Considering  the  limited  sup- 
plies within  his  reach,  and  the  many  urgent  demands  for  them 
from  all  sides,  it  is  a  source  of  astonishment  that  so  much  was 
accomplished  in  so  short  a  time.    Inadequate  preparations  had 


140 

been  made  for  casualties  on  such  a  large  scale,  but  he  made 
the  best  of  the  limited  resources  and  used  them  where  most 
needed,  often  regardless  of  prescribed  military  channels.  In 
less  than  four  days  nearly  1000  wounded  soldiers  sought  the 
shelter  of  his  tents.  During  this  trying  time  he  worked  inces- 
santly, regardless  of  his  own  health  and  personal  comforts. 
When  the  roll  of  honor  is  made  out  at  the  close  of  the  war,  the 
name  of  Major  LaGarde  deserves  a  well-merited  place  at  the 
head  of  the  list.  In  his  arduous  duties  he  was  ably  assisted 
by  Major  McCreary  and  Captains  Ireland  and  Fountleroy  of 
the  United  States  Army,  and  a  corps  of  acting  assistant  sur- 
geons. The  camp  is  on  the  shore,  on  a  limited  plateau  at  the 
base  of  the  mountain  rising  behind  the  little  mining  village. 
The  condition  of  the  wounded  men  furnished  satisfactory 
proof  that  good  work  had  been  done  here,  as  well  as  at  the 
front.  On  my  arrival  many  of  the  wounded  had  already  been 
placed  on  board  a  transport  ship,  but  more  than  100  remained 
in  the  general  hospital.  On  the  whole,  the  treatment  to  which 
the  wounded  men  were  subjected  was  characterized  by  con- 
servatism. Only  a  very  small  number  of  primary  amputations 
were  performed.  Bullets  that  were  found  lodged  in  the  body 
were  allowed  to  remain  undisturbed,  unless  they  could  be 
removed  readily  and  without  additional  risk.  A  number  of 
cases  of  penetrating  wounds  of  the  abdomen  and  chest  were 
doing  well  without  operative  interference.  Penetrating  gun- 
shot wounds  of  the  skull  were  treated  by  enlarging  the  wound 
of  entrance,  removal  of  detatched  fragments  of  bone,  and 
drainage.  Several  cases  in  which  a  bullet  passed  through  the 
skull,  injuring  only  the  surface  of  the  brain,  were  doing  well. 
With  few  exceptions,  wounds  of  the  large  joints  were  in  a  fair 
way  to  recovery  under  the  most  conservative  treatment. 

A  study  of  the  immense  amount  of  material  collected  at  this 
station  satisfied  the  surgeons  that  the  explosive  efi'ect  of  the 
small  caliber  bullet  has  been  greatly  overestimated.  The  sub- 
sequent employment  of  the  X-ray  in  many  of  these  cases  will 
undoubtedly  confirm  the  results  of  these  observations.  The 
battle  of  Santiago  resulted  in  157  killed  and  1300  wounded. 
Nearly  all  wounds  of  the  soft  parts  healed  rapidly.  Suppur- 
ation in  these  cases  was  the  exception,  primary  healing  the  rule. 
The  deceptive  nature  of  wounds  of  the  soft  parts  is  best  shown 


141 


by  a  case  of  gunshot  injury  of  the  knee-joint  that  came  under 
my  care  during  the  first  afternoon.  The  knee-joint  was  dis- 
tended to  its  utmost,  painful  and  tender  on  pressure.  A  rise 
in  temperature  and  corresponding  general  disturbances  indi- 
cated the  existence  of  infection.  A  small  opening  was  found 
over  the  inner  border  of  the  patella  on  a  level  with  the  articu- 
lations. A  careful  search  for  the  wound  of  exit  proved  negative. 
During  the  preparation  of  the  limb  for  the  operation  another 
effort  was  made  to  find  a  second  wound  with  the  same  result. 
After  the  patient  was  under  the  influence  of  the  anesthetic 
the  limb  was  rendered  bloodless  by  elastic  constriction  made 
at  its  base.  The  knee-joint  was  opened  freely  by  an  incision 
in  line  with  the  wound  of  entrance.  A  large  quantity  of  liquid 
blood  escaped.  A  furrow  on  the  surface  of  the  internal  condyle 
of  the  femur  led  to  a  deep  groove  in  the  under  surface  of  the 
patella,  and  taking  these  as  a  guide  the  wound  of  exit  was 
finally  discovered  with  the  groove  directly  over  the  inner 
surface  of  the  knee-joint  in  the  form  of  a  small  slit.  Through 
this  slit-like  opening  a  probe  was  inserted  and  advanced  into 
the  grooves  in  a  straight  line  without  any  difficulty.  There 
could  remain  no  further  doubt  as  to  the  existence  of  a  wound 
of  exit.  The  joint  contained  a  large  quantity  of  blood,  but 
no  detached  fragments  of  bone.  The  joint  was  washed  out 
with  a  2  per  cent,  solution  of  carbolic  acid,  the  capsule  sewed 
with  catgut  and  the  external  wounds  with  silk  and,  after 
dressing,  the  limb  was  immobilized  by  the  use  of  a  posterior 
splint,  made  of  the  sheath  of  the  palm  leaf.  The  patient  was 
doing  well  when  sent  home  on  a  transport,  two  days  later. 

AFTER    THE    BATTLE. 

The  day  after  my  arrival  I  went  to  the  front,  about  ten  miles 
from  Siboney.  A  colored  orderly  was  my  only  companion  ;  he 
rode  at  a  respectful  distance  to  the  rear.  The  whole  distance 
the  road  was  crowded  with  mule  teams,  soldiers  and  refugees. 
The  refugees  made  up  a  seething  mass  of  humanity  from  start 
to  finish.  At  a  low  estimate,  1  must  have  passed  on  that  day 
two  thousand  souls,  including  men,  women,  children  and  naked 
infants.  The  day  was  hot,  and  the  suffering  of  the  fleeing 
inhabitants  of  Santiago,  the  besieged  city,  and  adjacent  villages 
can  be  better  imagined  than  described.  Indian  fashion,  the 
women  walked  while  some  of  the  men  enjoyed  the  pleasure  of 


142 

a  mule-  or  donkey-ride.  Most  of  them  were  barefoot  and  dressed 
in  rags  ;  children  and  infants  naked.  Dudes  with  high  collar, 
white  necktie  and  straw  hat  were  few  and  far  between.  An 
occasional  old  umbrella  and  a  well-worn,  recently- washed  white 
dress  marked  the  ladies  of  distinction.  Their  earthly  posses- 
sions usually  consisted  of  a  small  bundle  carried  on  the  heads  of 
the  women,  or  a  worn-out  basket  meagerly  loaded  with  mangoes 
or  cocoanuts.  The  color  of  the  skin  of  the  passing  crowd  pre- 
sented many  tints,  from  white  to  jet-black.  The  women  were 
noted  for  their  ugliness,  the  men  for  their  eagerness  to  get  be- 
yond the  reach  of  guns.  Little  squads  of  Cuban  soldiers  were 
encountered  from  time  to  time,  apparently  anxious  to  get  only 
as  far  as  the  rear  of  our  advancing  army.  These  men  display 
an  appearance  of  courage  jusr  now  that  is  something  mar- 
vellous. Before  the  blue  coats  came  here  they  infested  the 
inaccessible  jungles  at  a  safe  distance  from  the  Spanish  guns, 
making  an  occasional  midnight  raid  to  keep  the  Spaniards  on 
the  lookout ;  now  they  can  be  seen  on  the  roads  in  small  groups 
relating  to  each  other  how  they  cut  down  the  Spanish  marines 
with  their  national  weapon  on  reaching  the  shore  after  their 
vessels  were  demolished  by  our  navy.  The  ragged  refugees, 
fleeing  in  all  directions  and  mingling  freely  with  our  troops,  as 
they  do,  carry  with  them  the  filth  of  many  generations  and  a 
rich  supply  of  yellow  fever  germs,  which  will  ultimately  kill 
more  of  our  men  than  the  Spanish  soldiers.  On  the  way  to 
the  front  Chicago  push  and  enterprise  came  in  evidence  by  the 
appearance  of  a  mule  of  the  smallest  species  carrying  a  rider 
all  out  of  proportion  in  size  to  the  diminutive  animal.  Sus- 
pended from  the  neck  and  dangling  over  the  breast  of  the 
animal,  was  a  piece  of  pasteboard  on  which  was  inscribed, 
''The  Chicago  Record.''  To  my  question,  "How  is  the  Chicago 
Record?''  the  rider  answered,  "AH  sold  out."  On  reaching 
General  Shafters  headcjuarters,  I  reported  to  Lieut. -Colonel 
Pope,  Chief  Surgeon  of  the  Fifth  Army  Corps.  Colonel  Pope 
has  worked  night  and  day  since  the  troops  landed  here.  He 
has  done  all  in  his  power  to  make  his  limited  supplies  meet  the 
enormous  demands.  At  headquarters  is  the  principal  field 
hospital,  in  charge  of  Major  Wood,  a  graduate  of  Rush  Medical 
College,  ably  assisted  by  Major  Johnson  and  a  corps  of  acting 
assistant-surgeons.     At  the  time  of   my  arrival,  68  wounded 


143 

officers  and  men  were  under  treatment  at  this  hospital.  Major 
Wood  kindly  invited  me  to  perform  an  amputation  of  the  thigh, 
for  gangrene  caused  by  a  gunshot  injury,  which  had  fractured 
the  lower  portion  of  the  femur  and  cut  the  popliteal  artery. 
The  wound  of  entrance  was  over  the  inner  margin  of  the 
patella  and  that  of  exit  over  the  lower  and  outer  agpect  of  the 
thigh.  The  knee-joint  and  thigh  were  enormously  swollen  and 
the  gangrene  had  extended  to  within  a  few  inches  of  the  knee- 
joint.  The  pulse  was  rapid  and  the  temperature  over  105 
degrees  F,  The  amputation  was  made  at  the  seat  of  fracture, 
above  the  condyles  of  the  femur,  by  making  a  long  oval  anterior 
and  a  short  oval  posterior  flap.  The  vessel  was  tied  above  the 
seat  of  injury.  Notwithstanding  the  extensive  edema  of  the 
tissues,  the  wound  was  in  excellent  condition  three  days  later, 
and  the  temperature  normal.  Here  I  found  many  interesting 
cases  on  the  way  to  recovery  in  which  the  nature  of  the  injury 
would  have  been  ample  excuse  for  rendering  a  very  grave  prog- 
nosis— among  them  a  number  of  cases  of  penetrating  wounds 
of  the  chest  and  abdomen.  Four  laparotomies  for  gunshot 
wounds  were  made  here  by  a  volunteer  surgeon,  but  as  all  the 
patients  died  it  was  deemed  expedient  to  assign  him  for  duty 
at  a  place  where  he  could  do  more  good  than  harm. 

IN    THE   CAMP    OF    THE    ENEMY. 

In  the  afternoon  I  accompanied  Acting  Assistant-Sur- 
geon Goodfellow  to  El  Caney.  The  trip  was  made  for  the 
purpose  of  taking  charge  of  sixteen  wounded  Spaniards  we 
were  to  transfer  to  the  Spanish  Army.  On  the  way  to  El  Caney 
we  found  many  recent  graves  and  numerous  dead  horses  cov- 
ered only  with  a  few  inches  of  dirt.  The  stench  from  this 
source  in  some  places  was  almost  unbearable.  The  little 
village  of  El  Caney  is  located  on  the  summit  of  a  hill  with  an  old 
dilapidated  church  for  its  center.  The  public  square  and  the 
few  streets  were  thronged  with  refugees,  from  8000  to  10,000 
in  number.  Crowds  of  refugees  were  also  seen  in  the  woods 
around  this  village  gathering  mangoes  and  cocoanuts,  about 
the  only  food  supply  at  this  time.  In  the  vestry  room  of  the 
church  we  found  a  representative  of  the  Red  Cross  Associa- 
tion dealing  out  hardtack  and  flour  to  the  hungry  multitude. 
The  wounded  Spaniards  were  lying  in  a  row  on  the  floor  of  the 
church,  one  of  them  in  a  dying  condition.     All  that  could  be 


144 


transported  were  conveyed  in  four  ambulances  under  a  small 
detachment  of  troops  to  our  fighting  line.  Here  a  flag  of 
truce  was  received,  which  was  carried  by  an  orderly,  the 
detachment  was  left  behind  and  we  passed  our  line.  As  soon 
as  the  Spanish  intrenchments  came  in  sight  the  signal  was 
given  and  was  promptly  answered  by  the  enemy.  Two  officers 
with  a  flag  of  truce  advanced  toward  us  and  we  were  halted  at 
a  little  bridge  very  near  Santiago  and  below  the  first  intrench- 
ment.  We  were  received  very  courteously  by  the  officers  and 
asked  to  a  seat  upon  the  grass  in  the  shade  of  a  clump  of 
trees.  Rum,  beer  and  cigarettes  were  furnished  for  the  enter- 
tainment of  the  callers.  The  object  of  the  visit  was  explained, 
whereupon  a  hospital  corps  of  about  thirty  men  with  sixteen 
litters,  in  charge  of  a  captain  of  the  line  and  a  medical  officer, 
made  their  appearance.  The  wounded  men  were  unloaded 
from  the  ambulances  and  conveyed  on  litters  to  within  the 
Spanish  line.  The  visit  was  such  a  cordial  and  pleasant  one 
that  we  found  it  very  difficult  to  part  from  our  newly  made 
friends.  After  bidding  the  officers  a  hearty  adieu  and  mount- 
ing my  horse,  I  was  urged  to  dismount  and  say  another  fare- 
well, a  request  which  was  responded  to  with  pleasure.  The 
two  little  parties  then  separated  and  made  their  way  in  a  slow 
and  dignified  manner  in  the  direction  of  the  respective  breast- 
works. 

ARTILLERY    ATTACK. 

The  first  armistice  expired  at  noon,  July  11.  In  the  after- 
noon a  heavy  cannonading  commenced  and  was  kept  up  until 
late  in  the  evening.  Next  morning  it  was  resumed,  however 
with  less  vigor.  During  this  bombardment  the  Spaniards 
renewed  their  recently  gained  reputation  as  effective  marks- 
men. One  of  our  best  cannons  was  hit  and  literally  lifted  into 
the  air.  An  officer  was  killed  and  a  number  of  men  injured. 
During  the  afternoon,  while  cannonading  was  still  going  on, 
I  went  to  the  front,  but  on  reaching  our  line  bombardment 
was  discontinued,  and  under  a  flag  of  truce  the  commanding 
generals  met  and  held  a  conference.  The  result  of  this  inter- 
view remains  a  secret  to  this  hour. 

GENERAL    MILES    ARRIVES. 

Major-General  Miles  and  stafi"  reached  Siboney,  yesterday, 
on  the  steamer  Yale  and  today  he  proceeded  to  headquarters. 


145 

The  appearance  of  yellow  fever  at  dififerent  places  occupied  by 
our  army  has  made  our  troops  more  anxious  than  ever  to  com- 
plete their  task.  The  frequent  drenching  rains  and  inadequate 
equipments  have  also  done  much  to  render  the  men  restless 
and  anxious  to  fight. 


RECENT  EXPERIENCES  IN  MILITARY  SURGERY 
AFTER  THE  BATTLE  OF  SANTIAGO. 


On  Board  the  Hospital  Ship  "Relief," 
July  22,  1898. 

WOUND    infections. 

Military  surgery  is  no  more  no  less  than  emergency  surgery 
in  civil  practice.  The  surgeon  in  daily  practice  has  learned 
long  ago  that  every  accidental  wound  must  practically  be 
regarded  and  treated  as  an  infected  wound.  In  this  respect 
the  military  surgeon  of  today  has  the  advantage  over  his  col- 
league in  civil  practice  in  knowing  that  the  small  caliber  bullet 
inflicts  wounds  which  per  se  are  more  often  aseptic  than  sep- 
tic. Our  recent  experience  in  Cuba  has  shown  that  the  small 
jacketed  bullet  seldom  carries  with  it  into  the  tisssues  clothing 
or  any  other  infectious  substances.  Most  of  the  wounds  of 
the  soft  tissues,  uncomplicated  by  visceral  lesions,  which 
in  themselves  would  become  a  source  of  infection,  healed  by 
primary  intention  in  a  remarkably  short  time.  If  infection 
followed  it  usually  did  so  in  the  superficial  portion  of  the 
wound  in  connection  with  the  skin,  and  what  is  more  than  sug- 
gestive, the  wound  of  exit  was  more  frequently  aifected  than 
the  wound  of  entrance.  This  can  be  readily  explained  from 
the  larger  size  of  the  wound  and  more  extensive  laceration 
and  tearing  of  the  tissues.  In  many  of  the  cases  ideal  healing 
of  the  wound  did  not  occur,  owing  to  a  subsequent  limited 
superficial  suppuration  of  the  wound.  The  deep  tissues  were 
seldom  implicated  in  such  cases.  I  have  reason  to  believe  that 
some  of  the  compound  fractures  which  are  now  suppurating 
had  such  a  source  of  infection,  that  is  the  extension  of  a  super- 
ficial infection  to  the  seat  of  fracture.  Two  weeks  have  now 
elapsed  since  the  battle  of  Santiago  was  fought  and  we  are 
now  in  a  position  to  inquire  more  critically  into  the  manner  in 
which  "the  wounds  became  infected.  The  many  failures  in 
protecting  the  more  serious  wounds  against  infection  are  at- 
tributable to  three  principal  causes :  1.  Inadequate  supply  of 


147 

first  dressing.  2.  Faulty  application  of  first  dressing.  3,  Un- 
necessary change  of  dressing.  The  medical  officers  with  the 
regiments  and  in  the  field  hospitals  were  hampered  in  their 
work  by  an  insufficiency  of  proper  material.  The  rapidity  with 
which  the  invasion  was  planned  and  executed,  the  difficulties 
encountered  in  transporting  the  hospital  supplies  to  the  front 
and  the  unexpected  large  number  of  wounded  readily  explain 
the  lack  of  dressing  material  when  it  was  most  needed. 
Many  of  the  dressings  were  too  small  and  not  sufficiently 
secured  to  keep  them  in  place  in  transporting  the  wounded 
from  the  front  to  the  field  hospitals.  As  a  rule  not  enough 
attention  was  paid  to  the  immobilization  of  the  injured 
part,  an  important  element  in  securing  rest  for  the  wound  and 
in  guarding  against  displacement  of  the  dressings.  It  is  a  source 
of  regret  that  plaster-of-Paris  dressings  were  not  more  fre- 
quently employed  in  the  treatment  of  gunshot  fractures  of  the 
extremities.  Another  very  palpable  evil  in  causing  infection 
was  the  too  common  practice  of  unnecessary  change  of  dress- 
ing. The  transfer  of  patients  fBom  one  surgeon  to  another 
could  not  be  avoided.  Patients  brought  from  the  first  dressing 
station  to  the  Field  Hospital  usually  weresubjected  to  a  change 
of  dressing  and,  when  a  few  days  later  they  reached  the  Gen- 
eral Hospital  at  Siboney,  they  had  to  undergo  the  same  ordeal 
and  often  not  only  once,  but  as  often  as  they  came  into  the 
hands  of  another  surgeon.  Patients  not  thus  treated  were  dis- 
satisfied, as  the  laymen  are  still  laboring  under  the  erroneous 
impression  that  the  oftener  a  wound  is  dressed  the  quicker  it 
will  heal.  It  is  difficult  to  eradicate  such  a  deep  rooted  and 
time-honored  belief,  and  patients  will  continue  to  clamor  for 
a  change  of  dressing,  and  the  good-natured,  hard-working  sur- 
geons only  too  often  yield  to  such  unreasonable  requests.  The 
evil  of  meddlesome  surgery  has  become  very  apparent  during 
our  brief  Cuban  campaign  and  has  taught  us  an  important 
lesson  that  must  be  heeded  in  the  future.  Our  military  sur- 
geons must  learn  to  realize  the  value  and  importance  of  the  first 
aid  dressing.  In  all  cases  in  which  the  first  examination  does 
not  reveal  the  existence  of  complications  which  require  subse- 
quent operative  treatment  the  diagnosis  tag  should  convey  this 
important  instruction:  ^'Dressing  not  to  be  touched  unless 
symptoms  demand  it.     Such  instruction  is  significant  and  must 


148 


be  followed  to  the  letter  by  all  surgeons  in  subsequent  charge 
of  the  patient. 

I  am  satisfied  more  than  ever  of  the  necessity  of  including 
in  the  first  aid  dressing  package  an  antiseptic  powder.  For 
years  I  have  used  for  this  purpose  a  combination  of  boracic 
acid  and  salicylic  acid,  4  : 1,  with  the  most  satisfactory  resuits. 
I  am  also  partial  to  absorbent  sterile  cotton  for  this  particular 
purpose,  as  it  constitutes  a  more  perfect  filter  than  loose  gauze. 
A  teaspoonful  of  this  powder  dusted  on  the  wound  forms  with 
the  blood  that  escapes  and  the  overlj'ing  cotton  a  firm  crust, 
which  seals  the  wound  hermetically.  Should  the  primary 
dressing  become  saturated  with  blood,  the  same  powder  should 
be  dusted  over  the  wet  dressing,  and  an  additional  compress 
of  cotton  is  added  to  the  dressing.  After  the  first  dressing  has 
been  applied  it  should  not  be  removed  except  for  good  and  sub- 
stantial reasons.  Much  can  be  done  in  the  after-treatment  in 
the  way  of  readjusting  the  bandage  and  in  immobilizing  the 
injured  part,  but  the  first  dressing  must  remain  unless  local  or 
general  symptoms  set  in  which  would  warrant  its  removal. 
Malaria  and  yellow  fever,  that  crept  in  upon  us  so  insidiously, 
are  responsible  for  many  unnecessary  changes  of  dressing.  The 
appearance  of  fever  in  a  wounded  man  naturally  leads  to  the 
suspicion  that  there  is  something  wrong  in  the  wound.  Many 
dressings  were  changed  on  this  ground,  nothing  abnormal  was 
found  in  the  wounds,  and  a  day  or  two  later  the  nature  of  the 
fever  was  recognized  and  the  patients  were  either  given  quinine 
or  were  sent  to  the  yellow  fever  hospital,  in  accordance  with 
the  diagnosis  made.  Every  change  of  dressing,  more  espe- 
cially in  military  practice,  is  attended  by  risk  of  infection 
and  must  be  scrupulously  avoided,  unless  local  or  general 
symptoms  indicate  the  existence  of  complications  ichich  de- 
mand surgiccd  intervention.  In  writing  the  above  it  is  not 
my  intention  to  cast  any  reflection  on  the  work  of  our  surgeons  ; 
on  the  contrary,  I  willingly  bear  witness  to  the  ability,  faith- 
fulness and  unselfishness  with  which  they  have  done  their 
duty.  A  better  and  more  conscientious  group  of  medical  offi- 
cers it  would  be  difficult  to  select  anywhere.  The  results  on 
the  whole  are  excellent,  but  I  am  hopeful  that  they  can  be 
improved  in  the  future  by  placing  more  stress  and  attention  to 
the  value  and  importance  of  the  first   dressing,  and  wish  to 


,149 

repeat  again  and  in  a  most  forcible  way  the  language  of  the 
late  Professor  von  Nussbaum  :  ''The  fate  of  the  wounded 
rents  in  the  hands  of  the  one  who  applies  the  first  dressing.'' 
If  this  is  true  in  civil  practice,  its  meaning  can  not  be  misin- 
terpreted in  military  surgery. 

EFFECTS    OF    BULLETS    ON    THE    SOFT    TISSUES. 

In  recent  cases  the  small  tubular  wound  made  by  the  Mauser 
bullet  was  surrounded  by  a  narrow  zone  of  contused  tissue,  and 
the  wound  space  itself  filled  either  with  liquid  or  coagulated 
blood.  A  few  days  later  the  wound  itself  was  found  surrounded 
with  an  area  of  suggillation,  which  varied  in  extent  according 
to  the  nature  of  the  tissues  and  the  amount  of  extravasation. 
In  cases  in  which  the  bullet  passed  through  the  tissues  some 
distance,  and  not  far  from  the  surface  of  the  skin  the  location 
and  direction  of  the  wound  canal  was  indicated  by  discolora- 
tion of  the  skin  a  few  days  after  the  injury  occurred.  In  a 
number  of  cases  of  aseptic  wounds  in  which  the  bullet  had 
lodged  in  the  tissues  and  was  removed  a  week  or  ten  days  later, 
I  had  an  opportunity  to  study  the  remote  effects  of  the  injury 
on  the  tissues.  In  all  cases  the  swelling  of  the  tissues  at  this 
time  had  nearly  or  entirely  obliterated  the  tubular  wound,  the 
location  of  which  was  indicated  by  a  dark  discoloration,  paren- 
chymatous extravasation,  remains  of  fluid  or  coagulated  blood, 
and  a  limited  area  of  edema  and  infiltration.  These  conditions 
served  as  a  useful  guide  in  following  the  course  of  the  bullet. 
The  bullet  itself  was  usually  found  loose  in  a  small  cavity  filled 
with  liquid  blood  or  bloody  serum,  while  a  more  extensive  zone 
of  infiltration  indicated  the  early  stage  of  encapsulation.  I 
have  no  further  doubt  but  what  the  new  bullet  will  become 
encapsulated  and  remain  harmless  in  the  tissues,  as  readily  or 
more  so  than  the  old-fashioned  leaden  bullet.  In  isolated  cases 
late  suppuration  at  the  seat  of  the  bullet  resulted  in  the  form- 
ation of  a  circumscribed  abscess,  a  complication  which  aided 
the  surgeons  in  locating,  finding  and  removing  the  missile.  It 
was  a  surprise  to  us  all  to  find  that  in  more  than  10  per  cent, 
of  all  the  wounded,  the  bullet  was  found  lodged  in  the  tissues, 
a  vastly  greater  number  than  we  had  any  reason  to  expect. 
The  reason  for  this  became  apparent  when  we  began  to  study 
the  condition  of  the  bullets  removed.  A  large  proportion  of 
the  bullets  removed  were  found  deformed,  showing  that  they 


150 


were  deflected  bullets,  which  had  struck  a  hard  object  or  passed 
through  a  resisting  medium  before  they  reached  the  final  ob- 
ject for  which  they  were  intended.  The  ground  upon  which 
the  battle  was  fought  is  stony  and  covered  with  trees  and  thick 
underbrush,  furnishing  the  most  favorable  conditions  for  de- 
flection of  the  missiles.     Some  of  the  firing  was  done  at  a  great 


n 


u 


Fig.  1.  Fig.  2.  Fig.  3. 

distance,  so  that  occasionally  a  spent  ball  was  found  in  the 
soft  tissues  without  injury  of  the  bones.  Such  a  bullet  is  shown 
in  Fig.  1.  The  bullet  is  a  nickel  encased  Mauser  projectile, 
natural  size,  the  jacket  perfect,  and  was  removed  from  behind 
the  tibia  about  four  inches  above  the  ankle  joint.  It  entered 
the  calf  of  the  leg  below  the  popliteal  space  and  never  touched 


Fig.  4.  Fig.  5. 

the  bone.  Fig.  2  represents  the  same  kind  of  a  bullet,  the 
point  flattened  and  mushroomed,  removed  from  the  head  of 
the  tibia.  This  bullet  was  probably  fired  from  a  great  distance, 
and  the  deformity  was  produced  by  the  bone.  Figs.  3,  4,  5, 
represent  a  nickel-clad  bullet  very  much  deformed.  It  was 
found  lodged  in  the  deep  tissues  of  the  thigh  about  two  inches 


151 


from  the  wound  of  entrance,  slightly  overlapping  the  femur 
near  the  middle  of  the  shaft.  The  bullet  evidently  struck  a 
stone  behind  its  point,  and  was  deflected  before  it  entered  the 
tissues.  It  was  much  flattened  and  curved.  Fig.  3  shows  the 
convex  side  point  of  bullet  and  jacket  perfect.  Fig.  i  shows 
the  edge  and  curve  of  the  bullet.  Fig.  5  represents  the  convex 
side,  showing  a  wide  rent  in  the  jacket  indicated  by  the  dotted 
lines,  the  lead  exposed  between  them.  Figs.  6,  7,  8,  illustrate 
the  deformity  of  a  large  caliber  brass  clad  bullet.  As  the  bul- 
let was  removed  from  the  soft  tissues  from  a  wound  without 
bone  injury,  the  deformity  must  have  been  caused  outside  of 
the  body.  The  bullet  is  flattened  on  one  side  from  a  point  near 
the  tip  to  near  the  base  of  the  lead  core.  Fig.  6  shows  the 
convex  side  ;  behind  the  last  transverse  groove  the  lead  is  ex- 


Fiff.  7. 

posed.  Fig.  7  illustrates  the  flattened  side  of  the  dotted  line, 
indicating  a  defect  in  the  brass  jacket.  Fig.  8  shows  the 
margin  of  the  bullet,  and  the  location  and  extent  of  flattening. 
As  the  Spanish  army  is  armed  exclusively  with  the  Mauser 
rifle,  the  weapon  from  which  this  bullet  was  fired  must  have 
been  in  the  hands  of  a  volunteer,  or  possibly  a  Cuban, 

THE    VALUE    OF    THE    X-RAY    IN    MILITARY    PRACTICE. 

The  use  of  the  probe  as  a  diagnostic  instrument  in  locating 
bullets  in  modern  military  service  has  been  almost  entirely 
superseded  by  dissection  and  the  employment  of  the  X-ray.  If 
from  the  nature  of  the  injury  and  the  symptoms  presented  the 
bullet  is  located  in  a  part  of  the  body  readily  and  safely  acces- 
sible to  the  knife  and  it  is  deemed  advisable  and  expedient  to 
remove  it,  this  can  often  be  done  more  expeditiously  and  with 


15-^ 


a  greater  degree  of  certainty  by  enlarging  the  track  made  by 
the  bullet  than  by  relying  on  the  probe  in  finding  and  on  the 
forceps  in  extracting  the  bullet.  If,  as  is  often  the  case,  the 
whereabouts  of  the  bullet  is  not  known,  its  presence  and  exact 
location  can  be  determined  without  any  pain  or  any  additional 
risks  to  the  patient  by  the  use  of  the  X-ray.  All  of  the  bullets 
removed  on  board  the  hospital  ship  Relief  were  located  in  this 
manner.  Dr.  Gray,  an  expert  in  skiagraphy,  who  has  charge 
of  the  scientific  work  of  the  floating  hospital,  has  been  of  the 
greatest  service  to  the  surgeons  in  enabling  them  to  locate  bul- 
lets and  in  guiding  them  as  to  the  advisability  of  undertaking 
an  operation  for  their  removal.  His  large  collection  of  skia- 
graph pictures  will  also  furnish  a  flood  of  new  light  on  the 
effects  of  the  small  caliber  bullet  on  the  different  bones  of  the 
body.  Dr.  Gray's  work  will  constitute  an  essential  and  endur- 
ing corner-stone  of  a  much-needed  modern  work  on  military 
surgery.  The  skiagraph  has  enabled  us  to  diagnosticate  the 
existence  or  absence  of  fracture  in  a  number  of  doubtful  cases 
in  which  we  had  to  depend  exclusively  on  this  diagnostic  re- 
source. In  fractures  in  close  proximity  to  large  joints  the 
X-ray  has  been  of  the  greatest  value  in  ascertaining  whether 
or  not  the  fracture  extended  into  the  joint.  In  one  case  of 
gunshot  wound  at  the  base  of  the  thigh  in  which  the  bullet 
passed  in  the  direction  of  the  trochanteric  portion  of  the  femur, 
opinions  were  at  variance  concerning  the  extent  of  injury  to 
the  bone.  Some  of  the  surgeons  made  a  diagnosis  of  fracture 
while  others  contended  that  there  was  no  fracture  but  believed 
that  the  bullet  had  made  a  deep  groove  in  the  anterior  portion 
of  the  bone  and  had  possibly  opened  the  capsule  of  the  joint  at 
the  same  time.  The  X-ray  picture  clearly  demonstrated  the 
absence  of  fracture  and  the  existence  of  a  deep  furrow  with 
numerous  fragments  on  each  side.  The  X-ray  apparatus  also 
proved  of  the  greatest  practical  utility  in  showing  the  displace- 
ment of  fragments  in  gunshot  fractures  of  the  long  bones, 
which  enabled  the  surgeons  to  resort  to  timely  measures  to 
prevent  vicious  union.  The  fluoroscope  has  greatly  added  to 
the  practical  value  of  skiagraphy.  In  the  light  of  our  recent 
experience  the  X-ray  has  become  an  indispensable  diagnostic 
resource  to  the  military  surgeon  in  active  service,  and  the  sug- 
gestion that  every  chief  surgeon  of  every  army  corps  should  be 


153 


supplied  with   a  portable  apparatus  and  an  expert  to  use  it, 
must  be  considered  a  timely  and  urgent  one. 

THE   WOUNDED   OF   THE   BATTLE  OF   SANTIAGO. 

It  will  be  of  interest  to  the  profession  to  learn  something  defi- 


Fig.  9. 

nite  of  the  nature  of  the  wounds  and  their  more  remote  results 
on  the  victims  of  Spanish  bullets  in  the  battle  of  Santiago. 
Two  weeks  have  passed  away  since  the  battle.  A  considerable 
number  of  the  wounded  have  died  since,  and  many  have  left 
for  the  United  States  on  the  Olivette,  Solace  and  transport 


154 


ships.  Among  the  130  wounded  now  on  the  way  to  their  homes 
on  the  hospital  ship,  Relief,  I  have  selected  a  number  of  cases 
of  more  than  usual  interest,  for  the  purpose  of  studying  the 
effects  of  the  small  caliber  bullet,  immediate  and  remote,  on 
the  different  organs  and  regions  of  the  body.  It  is  my  inten- 
tion to  give  the  course  of  the  bullets  by  marking  on  the  dia- 
grams accompanying  the  report  of  each  case,  the  wound  of 
entrance  and  exit.  A  study  of  the  diagrams  will  show  that 
deflection  of  the  bullet  in  the  body  is  exceptional.  Asa  rule, 
the  wound  canal  was  in  a  perfectly  straight  line  from  one 
wound  to  the  other.  By  following  the  track  of  the  bullet  it  is 
not  difficult  to  determine  the  organ  or  organs  implicated  in  the 
injury.  I  shall  classify  the  cases  so  as  to  embrace  gunshot 
wounds  of  1,  the  head  ;  2,  the  neck  ;  8,  the  spine  ;  i,  the  chest ; 
5.  the  abdomen ;  6,  the  extremities. 

C4U>rSHOT  WOUNDS  OF  THE  HEAD. 

To  my  own  knowledge,  a  number  of  gunshot  wounds  of  the 
head  that  survived  long  enough  to  be  transported  to  the  gen- 
eral hospital  at  Siboney,  died  within  twelve  days  after  the 
receipt  of  the  injury.  In  all  of  the  cases  intracranial  infec- 
tion was  the  immediate  cause  of  death.  Encephalitis  and 
leptomeningitis  constituted  the  fatal  complications.  The  be 
ginning  of  the  intracranial  inflammation  was  always  announced 
by  cerebral  hernia,  which  in  size  was  proportionate  to  the 
extent  and  intensity  of  the  inflammatory  process.  The  surgi- 
cal treatment  resorted  to  in  most  instances  proved  powerless 
in  limiting  the  infection.  If  these  cases  had  been  studied  with 
a  little  more  care  during  life,  and  if  postmortem  examinations 
had  been  made  more  frequently,  valuable  material  could  have 
been  obtained  for  the  advancement  of  the  as  yet  imperfectly 
developed  science  of  cerebral  localization. 

Case  1. —  Fred  Shockley,  Company  D,  Tenth  Cavalry, 
wounded  July  2.  When  injury  was  received  the  patient  was 
lying  on  his  abdomen  with  chest  and  head  extended  at  the 
base  of  the  ridge  occupied  by  the  enemy,  which  position  readily 
explains  the  unusual  course  of  the  bullet.  The  bullet  struck 
the  occipital  base  at  a  tangent,  producing  a  comminuted  frac- 
ture with  depression  ;  it  then  made  a  deep  groove  in  the  back 
of  the  neck  and  then  re-entered  the  body  on  a  level  with  the 
first  rib  to  the  left  of  the  seventh  cervical   vertebra,   passed 


155 


through  the  chest  and  escaped  in  front  through  the  second 
intercostal  space,  a  little  to  the  left  of  the  mammary  line 
(Fig.  9).  Soon  after  the  injury  was  received  he  coughed  up  a 
small  quantity  of  blood  ;  no  hemorrhage  since  or  any  indica- 
tions of  pneumothorax,  pneumonia  or  pleuritis.  The  chest 
wounds  healed  by  primary  intention.  At  first  had  convulsions 
for  a  few  moments  ;  no  loss  of  consciousness,  but  clonic  spasms 
of  both  arms.  At  present  intellect  is  unimpaired  ;  has  some 
headache  and  a  sensation  of  throbbing  in  the  head  ;  some  im- 
pairment of  motion  and  sensation  of  right  leg  and  complete 
loss  of  motion  of  toes  of  right  foot :  has  some  pain  in  eyes  and 
slight  dimness  of   vision. 

Case  2. — Patrick  Ward,  Company  I,  Third   Cavalry,  admit- 


ted from  hospital  at  Siboney  to  hospital  ship,  Relief,  July  11. 
Injury  probably  received  in  the  same  manner  as  in  Case  1.  A 
large  defect  in  the  occipital  bone  marked  the  wound  of  entrance 
and  exit  in  the  skull,  the  opening  enlarged  by  operation.  The 
linear  wound  below,  and  extending  as  far  as  the  last  cervical 
vertebra,  was  undoubtedly  made  in  following  and  removing 
the  bullet.  The  cranial  defect  and  course  of  bullet  are  out- 
lined in  Figure  10. 

A  cerebral  hernia  projects  from  the  opening,  and  a  deep- 
seated  cerebral  abscess  was  recently  discovered,  opened  and 
drained.  In  part  the  hernia  is  covered  by  skin.  Both  parietal 
bones  are  the  seat  of  a  comminuted  fracture.     Mental   facul- 


156 


ties  not  impaired ;  no  focal  symptoms.  The  patient  is  losing 
strength  rapidly  and  will  soon  succumb  to  the  intra-cranial 
lesion. 

Case  3. — Jerome  Russel,  Company  A ,  Thirteenth  Infantry? 
was  wounded  July  1.  When  brought  on  board  the  Relief  a 
cerebral  hernia  about  the  size  of  a  hen's  egg  was  found  over 
the  sagittal  suture,  an  inch  in  front  of  the  occipital  protuber- 
ance. The  wound  was  suppurating,  and  digital  exploration 
revealed  a  small  circular  opening  directly  in  front  of  the  occip- 
ital protuberance.  This  opening  was  evidently  the  wound  of 
entrance,  and  by  operation,  had  been  connected  with  the  wound 
of  exit  by  a  channel  an  inch  in  length  and  half  as  wide.     The 


Fig.  11. 

hernia  occcupied  the  wound  of  exit.  A  number  of  loose  frag- 
ments of  bone  have  been  removed  at  different  times.  There  is 
marked  hemiplegia  on  the  left  side,  the  forearm  is  strongly 
flexed  and  in  close  contact  with  the  cheat.  Sensation  is  not 
diminished;  speech  clear,  but 'ideas  confused;  pupils  react  to 
light ;  incontinence  of  urine  ;  extensive  decubitus  over  sacrum  ; 
temperature  100.5  degrees  F.  ;  pulse  and  respiration  normal. 

Case  4. — B.  C.  Parker,  Company  C,  Fourth  Infantry,  was 
wounded  July  1.  The  bullet  entered  the  left  temporal  region, 
comminuting  the  bone  in  that  region  extensively,  and  escaped 
oyer  the  left  frontal  eminence  (Fig.  11).  The  cranial  defect 
was  increased  by  the  removal  of  a  number  of  loose  fragments. 
There  had  been  quite  a  profuse  sero-purulent  discharge  from 
the  wound.     The  only  focal  symptom  consists  in  a  pricking 


157 


sensation  in  the  right  foot  or  chest  when  the  wound  is  being 
dressed.  His  mind  is  clear  most  of  the  time,  occasionally 
slight  confusion  and  wandering.  The  absence  of  cerebral  her- 
nia in  this  case  is  the  surest  indication  that  the  infection  is  local. 

GUNSHOT    WOUNDS    OF    THE    NECK. 

Case  o.— Lieut.  Albert  Scott,  Company  C,  Thirteenth 
Infantry,  on  July  1,  while  standing  with  his  company  at  the 
foot  of  a  hill,  during  the  advance  on  Santiago,  received  a 
wound  in  the  neck.  The  bullet  entered  the  neck  on  the  right 
side  just  below  the  inferior  maxillary  bone,  one  inch  in  front 
of  the  angle  of  the  jaw.  The  wound  of  entrance  is  a  clean  cut 
hole  about  the  size  of  a  lead  pencil.     The  course  of  the  bullet 


Fig.  12. 
was  backward  and  slightly  downward,  emerging  at  the  back  of 
the  neck  on  a  level  with  and  to  the  left  of  the  fifth  cervical 
vertebra  (Fig.  12). 

At  the  moment  the  injury  was  inflicted  he  felt  no  pain  in  the 
wound,  but  he  experienced  a  sensation  as  if  he  had  been 
grasped  by  the  wrists  and  thrown  violently  to  the  ground. 
The  wound  of  exit  is  of  the  same  size  and  appearance  as  the 
wound  of  entrance.  Very  slight  hemorrhage.  A  few  minutes 
after  receiving  the  injury  he  was  carried  from  the  firing  line  by 
members  of  his  company,  and  was  soon  transported  to  the 
First  Division  Hospital,  where  he  remained  for  ten  days,  after 
which  he  was  removed  in  an  ambulance  to  the  hospital  at 
Siboney,  a  distance  of  seven  miles  over  a  very  rough  road,  and 
a  day  later  was  transferred  to  the  Relief. 


158 


He  first  became  aware  of  the  existence  of  the  wound  on  the 
way  from  the  field  to  the  hospital.  At  the  time  he  came  on 
board  the  hospital  ship  he  was  voiceless,  and  made  constant 
efforts  to  clear  his  bronchial  tubes  of  mucus.  Complete  par- 
alysis of  right  arm  and  leg,  and  partial  loss  of  power  in  left 
arm  and  leg.  Respiration  normal,  but  an  almost  constant 
spasmodic  cough,  no  control  over  sphincters,  involuntary  pas- 
sages from  both  bladder  and  bowels,  great  debility  and  profuse 
sweating ;  complains  of  pain  all  over  the  body.  Morphia  and 
atropin  given  to  subdue  pain.  A  radiograph  taken  by  Dr. 
Gray  shows  an  injury  of  one  of  the  cervical  vertebrae,  probably 
the  fifth.  Injury  seems  to  be  to  the  left  of  the  body  of  the 
bone.      Has  received  no  treatment  other  than  complete  rest 


and  a  nightly  anodyne  as  noted  above,  which  secures  a  good 
night's  sleep,  and  markedly  diminishes  the  sweating.  Has 
regained  control  of  the  sphincters,  and  is  able  to  use  bed  pan 
and  urinal. 

July  19. — During  the  past  six  days  there  has  been  a  decided 
improvement  in  the  general  condition  of  the  patient.  He  is 
brighter  in  appearance,  he  can  articulate  more  distinctly,  and 
there  is  a  decided  return  of  power  in  the  right  leg.  The  right 
hand  is  still  absolutely  powerless,  but  the  grip  of  the  left  hand 
is  decidedly  stronger.     Appetite  and  circulation  good. 

July  21. — Improvement  in  general  condition  still  continues. 
The  external  wounds  healed  by  primary  intention,  and  the 
scars  can  only  be  seen  on  making  a  very  careful  inspection. 


159 


Trional  and  eulphonal  have  been  substituted  for  the  morphia. 

Case  ^.— Oscar  C,  Buck,  Company  P,  Second  Infantry,  was 
shot  by  a  sharpshooter  hiding  in  a  tree,  July  11.  The  bullet 
passed  through  the  neck  from  side  to  side.  The  first  and  only 
evidence  the  patient  had  that  he  was  injured  was  bleeding  from 
the  throat,  the  hemorrhage  at  first  being  quite  profuse.  Stiff- 
ness of  the  neck  and  pain  on  movement  have  been  the  only 
symptoms  complained  of  since.  The  bullet  entered  over  the 
sterno-cleido-mastoid  muscle  on  the  left  side,  about  two  and 
one-half  inches  from  the  mastoid  process.  The  wound  of 
entrance  was  circular  and  very  small ;  the  wound  of  exit  on 
the  same  level  but  about  half  an  inch  nearer  the  spine  (Fig.  13). 
Three  days  later  a  small  superficial  abscess  formed  in  the 
wound  of  exit,  which  was  evacuated  by  dilating  the  wound. 
Both  wounds  were  perfectly  healed  July  20.  Judging  from  the 
course  of  the  bullet  it  is  difficult  to  understand  how  the  princi- 
pal nerves  and  large  vessels  of  the  neck  escaped  injury.  This 
is  one  of  those  cases  that  require  careful  watching,  as  a  trau- 
matic aneurysm  may  develop  later  in  the  throat  if  the  bullet 
injured  the  external  tunics  of  either  of  the  carotid  arteries. 

Case  7.— Charles  F.  Flickinger,  Company  C,  Fourth  Infan- 
try, was  wounded  July  1,  while  lying  down.  The  bullet 
entered  the  left  posterior  cervical  triangle  on  a  level  with  the 
spinous  process  of  the  fifth  cervical  vertebra,  midway  between 
the  spine  and  the  posterior  border  of  the  sternocleido- mastoid 
muscle,  and  emerged  opposite  the  spinous  process  of  the 
seventh  dorsal  vertebra,  and  equidistant  from  that  point  and 
the  posterior  border  of  the  scapula  (Fig.  14a).  The  patient 
complains  of  severe  pain  in  shoulders  on  attempting  to  move, 
but  is  free  from  any  symptoms  that  would  indicate  any  injury 
to  the  spinal  cord.  He  was  within  100  yards  of  the  enemy 
when  he  was  wounded. 

GUNSHOT    WOUNDS    OF    THE    SPINE. 

All  cases  of  gunshot  wounds  of  the  spine  in  which  the  cord 
was  seriously  damaged  have  died,  or  will  die  in  the  near  future. 
The  immediate  cause  of  death  in  such  cases  is  either  a  septic 
leptomeningitis  or  sepsis  and  exhaustion  from  decubitus. 
Death  from  the  first  named  cause  takes  place  early  as  the 
result  of  infection  of  the  wound  and  extension  of  the  inflamma- 
tion at  the  seat  of  the  visceral  injury  along  the  meninges  and 


160 


surface  of  the  spinal  cord.  The  first  case  of  this  kind  I  saw 
was  at  El  Caney  a  few  days  after  the  battle  of  Santiago.  The 
patient  was  a  Spanish  prisoner.  I  found  hina  lying  on  the  bare 
stone  floor  of  the  village  church.  The  bullet  had  entered  over 
the  center  of  the  spine  at  the  junction  of  the  dorsal  with  the 
lumbar  vertebra^  its  course  apparently  being  directly  forward. 
Complete  paraplegia  below  the  seat  of  injury.  The  bladder 
was  distended,  nearly  reaching  the  level  of  the  umbilicus : 
incontinence  of  urine.  The  neck,  trunk  above  the  wound,  and 
upper  extremities  rigid  ;  fever  ;  pulse  rapid  and^small,  counten- 
ance extremely  pale.      The  wound  was  protected  by  a  small 


Fig. 14a. 

dirty  dressing,  and  was  suppurating.  I  doubt  not  that 
the  patient  died  in  less  than  twenty-four  hours  after  I  saw  him. 
Wounds  of  the  spine  without  injury  to  cord  were  frequently 
attended  by  temporary  paralysis  varying  greatly  in  degree  and 
duration. 

Case  8. — George  Kelly,  Company  C,  Seventeenth  Infantry, 
was  shot  July  1,  while  lying  in  a  prone  position.  The  bullet, 
which  was  fired  from  a  blockhouse  on  the  summit  of  a  hill,  at 
a  distance  of  about  600  yards,  entered  the  body  at  a  point  a 
little  below  and  at  the  middle  of  the  right  ilium,  and  emerged 
from  the  opposite  side  about  three  inches  below  the  crest  of 
the  left  ilium  (Fig.  14b).  The  patient  asserts  that  he  suffered 
intense  pain  immediately  after  he  was  shot,  and  that  he  is  now 


161 


free  from  pain  except  when  he  attempts  to  walk.  The  pain 
thus  caused  he  refers  to  the  sacrococcygeal  articulation.  The 
wounds  are  healed,  and  the  absence  of  paralysis  is  the  best 
evidence  that  the  contents  of  the  spinal  canal  escaped  injury, 


Fig.  Ub. 

although  the  bullet  must  have  passed  transversely  through  the 
first  sacral  vertebra. 

Case  9. — John  Robinson,  Company  C,  Twenty-fourth  Infan- 
try, The  bullet  entered  the  supraspinous  fossa  of  left  scapual 
and  escaped  from  the  right  lumbar  region,  having  perforated 
in  its  long  course  the  lung,  spinal  cord,  diaphragm  and  liver 


162 


(Pig.  15).  Wounds  healed  ia  ten  days.  Expectoration  bloody, 
complete  paraplegia.  Beginning  extensive  decubitus  over 
sacrum  and  spinous  processes. 

Case  lO.-Otto  Derr,  Company  A,  Twenty-first  Infantry,  was 


Fig.  15. 

wounded  July  2.  Bullet  passed  through  the  chest  from  side 
to  side  from  the  post-axillary  line  on  the  right  side  to  a  corres- 
ponding point  on  the  opposite  side,  on  a  level  with  the  seventh 
intercostal  space.  Complete  paralysis  of  motion  and  sensation 
below  the  seat  of  spinal  injury.  The  wounds  healed,  but  life 
was'threatened  at  the  time  from  a  commencing  septic  decubitus. 


163 


Case  :Zi.— Lewis  W.  Carlisle,  Company  K,  Seventy-first  New 
York  Volunteers,  was  hit  by  a  shrapnel  in  the  back,  on  a  level 
with  the  third  lumbar  vertebra,  shattering  the  spinous  and 
left  lateral  processes  of  the  same.  The  missile  was  removed  as 
soon  as  the  patient  reached  the  Division  Hospital.  As  profuse 
suppuration  set  in  and  continued,  the  patient  was  anesthetized 
July  18,  and  a  number  of  fragments  of  bone  removed.  A  large 
abscess  cavity  in  the  right  lumbar  region  communicated  with 
the  wound.  The  cavity  was  drained  by  making  a  counter- 
opening  in  line  with  Simon's  incision.  Impaired  sensation  in 
the  right  leg  was  the  most  important  local  symptom  in  this 
case. 

Case  i'>.— Charles  J.  Reardon,  Company  C,  Sixteenth 
Infantry,  was  wounded  by  a  fragment  of  shrapnel  which  struck 
him  as  he  lay  on  his  back  with  his  shoulders  raised  ready  to 
fire.  The  wound  was  directly  over  the  spine,  on  a  level  with 
the  fourth  dorsal  vertebra,  the  missile  evidently  opening  the 
spinal  canal  and  injuring  its  contents.  The  foreign  body 
remains  imbedded  in  the  tissues  ;  its  location  so  far  has  not 
been  determined.  Paraplegia  is  complete  below  the  level  of 
the  umbilicus.  On  July  18  the  patient  was  still  alive,  but  an 
extensive  moist  decubitus  became  the  direct  cause  of  death  in 
the  course  of  a  few  days. 

GUNSHOT    WOUNDS    OF    THE   CHEST. 

It  is  well  known  that  during  the  Civil  War  men 
had  a  better  chance  for  life  when  the  bullet  passed  through 
the  chest  than  when  the  chest  was  opened  and  the  ball  remov- 
ed. The  same  remains  true  now,  although  not  to  the  same 
extent,  as  the  small  caliber  bullet  is  less  likely  to  carry  with 
it  into  the  chest  clothing  or  other  infective  material.  The 
number  of  cases  of  chest  wounds  that  lived  long  enough  to 
reach  the  hospital  on  the  coast  is  still  more  astonishing,  and 
what  is  surprising  is  the  fact  that  unless  the  hemorrhage  was 
severe  the  symptoms  were  mild,  some  of  the  patients  being 
confined  to  bed  only  for  a  few  days.  All  of  these  cases  were 
treated  on  the  expectant  plan,  i.e.,  by  dressing  the  external 
wound  or  wounds  in  the  usual  manner.  In  no  instance  was 
the  pleural  cavity  opened  for  the  purpose  of  arresting  the 
hemorrhage. 


164 


Case  13. — Wm.  A.  Cooper,  Company  A,  Tenth  Cavalry,  was 
wounded  July  1.  The  bullet  entered  an  inch  below  the  left 
nipple,  and  escaped  from  the  body  an  inch  below  the  costal 
arch  in  the  mammary  line  (Fig.  16).  It  is  questionable  whether 
the  bullet  opened  either  the  pleural  or  peritoneal  cavity,  as  the 


Fig.  16. 

injury  was  not  followed  by  any  symptoms  referable  to  visceral 
wounds  of  the  chest  or  abdomen,  although  the  course  of  the 
bullet  was  such  as  to  give  rise  to  the  suspicion  that  either  or 
both  of  these  cavities  might  have  been  invaded. 
Case  14. — Edward  O'Flaherty,  Company  C,  Sixteenth  In- 


165 


fantry,  was  wounded  July  2  by  a  45-caliber  ball  from  a  bursting 
shrapnel.  The  projectile  entered  below  the  angle  of  the  right 
scapula,  passed  through  the  lung,  diaphragm  and  liver,  lodg- 
ing beneath  the  skin  in  front,  between  the  seventh  and  eighth 
ribs  (Fig.  17).  Bloody  expectoration  for  some  time  and  slight 
rise  in  temperature. 


Fiff.  17. 

July  12.— Temperature  normal. 

July  21.— Patient  suffers  but  little  inconvenience  from  his 
wound.  No  peritoneal  or  pleural  effusion.  General  condition 
promises  an  early  and  complete  recovery. 


166 


Case  15. — John  B.  Semca,  Company  G,  Twenty-second  In- 
fantry, was  wounded  July  1,  by  a  bullet  which  entered  his 
back  just  below  the  angle  of  the  left  scapula,  passed  upward 
through  the  lung,  neck  and  jaw  and   emerged   through  the 


Fig.  1- 


alveolar  process  of  the  right  bicuspid  tooth,  cutting  the  tongue 
slightly  (Fig.  18).  All  wounds  healed  in  a  short  time  by  pri- 
mary intention.  Hemoptysis  profuse  immediately  after  he  was 
shot,  and  slight  for  the  following  few  days.  Left  arm  at  first 
nearly  powerless,  with  desquamation  of  skin  of  the  hand. 
Function  of  the  arm  is  returning  gradually.     In  three  weeks 


J67 


the  patient  was  able  to  sit  up  for  a  short  time  each  day.  Phy- 
sical  examination  of  the  chest  at  this  time  revealed  nothing 
abnormal. 

Case  i6'.— Winslow  Clark,  Company  G,  First  Volunteer  Cav- 
alry, was  wounded  July  1,  by  a  bullet  which  entered  the  chest 


Fig.  18. 

by  first  perforating  the  left  scapula  through  the  infraspinous 
fossa,  three  inches  above  the  angle  and  a  inch  from  the  spinal 
border  (Fig.  19).  No  wound  of  exit.  The  probable  course  of 
the  bullet  was  downward  and  forward.  Some  hemoptysis  and 
fever.      No  vomiting  of  blood.      The  hemothorax  was  quite 


168 


extensive  and  was  relieved  by  tapping,  a  week  after  the  injury. 
He  is  now  (July  22)  convalescing  rapidly. 

Case  17. — Arthur  Fairbrother,  Company  C,  Third  Cavalry, 
sustained  a  perforating  gunshot  wound  of  the  chest  July  1. 


The  bullet  entered  the  chest  just  below  the  middle  of  the  right 
clavicle  (Fig.  20).  No  wound  of  exit.  Hemoptysis  rather  pro- 
fuse, followed  by  hemothorax.  Has  had  fever,  off  and  on, 
probably  malarial.  Patient  was  admitted  to  the  Relief  July  15. 
Wound    not    completely  closed.       On  coughing,   dark    fluid 


169 


blood  escapes.  Nearly  the  entire  pleural  cavity  filled  with 
blood.  Two  days  later  three  pints  of  dark  fluid  blood  were 
removed  by  tapping  and  siphonage.  Sputum  at  this  time  still 
bloody. 


Fig.  19. 

July  22.— Patient  much  improved.  No  signs  of  empyema. 
Hemothorax  diminished,  but  may  require  a  second  tapping. 

Case  m— Scanlon,  Company  K,  Third  Cavalry,  was  wounded 
on  the  second  day  of  the  battle  of  Santiago.  The  ball  entered 
the^chest  through  the  third  rib  midclavicular  line  on  the  right 


170 


side,  passed  downward  and  backward  and  escaped  in  the  gluteal 
region  on  the  same  side,  after  perforating  the  ilium  (Fig.  21). 
The  ball  must  have  passed  through  the  lung,  diaphragm  and 
liver.  Hemoptysis  slight,  but  distressing  nausea,  vomiting  and 
pain.  Admitted  to  the  hospital  ship  Relief  July  15.  At  that 
time  he  had  a  constant  temperature  ranging  between  100  and 
102  degrees  F.,  vomiting,  diarrhea  and  rapid  emaciation.  Great 
pain  over  the  liver  and  ascending  colon.  Hemothorax  and 
marked  swelling  in  the  region  of  the  liver  and  abdominal  cavity 


on  the  right  side.  Examination  of  urine  negative.  Owing  to 
the  great  debility  and  pronounced  anemia  it  was  not  deemed 
advisable  to  resort  to  laparotomy. 

Case  19. — Harry  Mitchell,  Company  C,  Seventh  Infantry, 
was  wounded  July  1.  The  bullet  entered  over  the  right  acro- 
mion process,  passed  through  the  apices  of  both  lungs  and 
escaped  through  the  second  intercostal  space  above  the  right 
nipple  (Fig.  22).  No  hemoptysis  at  any  time,  dry  cough  and  a 
moderate  hemothorax  on  the  right  side.  Has  suffered  from 
quotidian  form  of  malarial  fever,  which  is  yielding  to  quinin. 
A  speedy  and  complete  recovery  is  expected. 


171 


Case  '^0. — Lieut.  John  Robertson,  Company  Ci,  Sixth  Infantry, 
received  a  gunshot  wound  of  the  upper  third  of  right  thigh 
about  10  o'clock  July  1.  The  profuse  hemorrhage  was  partly 
controlled  by  an  improvised  tourniquet  applied  by  an  officer  of 
the  line.     He  was  carried  to  the  rear  by  the  men  of  his  corn- 


Fig,  21a. 
pany,  and  while  thus  conveyed  he  was  shot  in  the  left  breast, 
the  bullet  entering  just  below  the  left  nipple  and  passing 
through  the  chest  in  an  anteroposterior  direction  (Pig.  23). 
He  was  wounded  a  third  time,  the  bullet  grazing  the  inner  side 
of  the  left  knee.     The  first  dressing  was  applied  in  the  First 


172 


Division  Hospital.  The  fracture  of  the  thigh  was  dressed  by 
the  use  of  a  long  splint.  From  here  he  was  sent,  on  July  9,  to 
the  Third  Division  Hospital,  and  two  days  later  was  brought 
on  board  the  Relief.  At  this  time  both  chest  wounds  were 
healed.     The  thigh  wounds  remained  aseptic.     A  radiograph 


Fig.  21b. 

showed  great  displacement  of  the  fragments  by  overlapping. 
The  fracture  was  then  treated  by  confining  the  limb  upon  a 
double-inclined  plane,  consisting  of  a  hollow  posterior  splint 
made  of  the  sheath  of  the  leaf  of  the  cocoa  palm,  to  which 
was  added  an  anterior  thigh  splint  of  wire  gauze.    After  dress- 


173 


ing,  the  limb  was  placed  in  a  eliog.    No  pulmonary  or  pleuritic 
complications. 

Case  ^i.— Henry  T.  Darby,  Company  D,  Thirteenth  Infantry, 
received  a  perforating  gunshot  wound  of  the  chest  July  1.  The 
ball  entered  on  the  right  side,  above  the  angle  and  at  the  outer 


Fig.  22. 


border  of  the  right  scapula,  passed  through  the  chest  and 
escaped  through  the  fourth  intercostal  space  in  front,  on  the 
opposite  side,  two  inches  outside  of  the  mammary  line  (Fig.  24.) 
When  the  patient  came  on  board  the  Relief,  July  9,  he  com 
plained  of  great  difficulty  in  breathing  ;  he  was  pale  and  greatly 


174 


prostrated ;  temperature  102  degrees  F.  The  physical  signs 
indicated  the  presence  of  a  copious  pleuritic  effusion  on  the  left 
side.  The  chest  was  opened  by  an  incision  through  the  sixth 
intercostal  space,  in  the  axillary  line,  July  11.     About  three 


Fig.  23. 

pints  of  fluid  blood  escaped.     Gauze  drainage.     The  lung  ex- 
panded rapidly  and  the  patient  commenced  to  improve. 

No  further  doubt  can  remain  in  regard  to  the  difference  in 
the  mortality  of  gunshot  wounds  inflicted  with  the  large  and 
small  caliber  bullets.  The  cases  related  above  appear  to  prove 
that  the  danger  incident  to  gunshot  wounds  of  the  chest  made 


175 


by  the  small  projectile,  consists  in  complicating  injuries  involv- 
ing the  heart  and  large  blood-vessels,  and  that  in  the  absence 
of  such  injuries  the  prognosis  is  favorable.  It  seems  that  em- 
pyema is  a  rare  remote  result  of  such  injuries.  Rib  resection  and 
free  incision  and  drainage  of  the  chest  in  such  instances  must 
be  reserved  for  cases  in  which  a  positive  diagnosis  of  empyema 
can  be  made.  The  safest  and  best  treatment  for  hemothorax 
requiring  operative  interference  is  tapping  and  evacuation  by 
siphonage. 


Fig.  24a. 
GUNSHOT    WOUNDS    OF    THE    ABDOMEN. 

Our  recent  experience  in  Cuba  has  more  than  ever  confirmed 
my  conviction  that  not  infrequently  cases  of  penetrating  gun- 
shot wounds  of  the  abdomen  will  recover  without  active 
surgical  interference.  For  years  I  have  maintained,  as  the 
result  of  clinical  experience  and  experiments  on  the  cadaver, 
that  a  bullet  may  pass  through  the  abdomen  on  a  level  and 
above  the  umbilicus  in  an  antero  posterior  direction  without 
producing  visceral  injuries  demanding  operative  intervention. 
Elsewhere  the  results  of  my  experience  and  experimentation 
concerning  such  injuries  have  been  published.     If  the  bullet 


176 


traverses  the  small  intestine  area  it  is  more  than  probable  that 
from  one  to  fourteen  perforations  will  be  found. 

Four  laparotomies  for  perforating  gunshot  wounds  of  the 
abdomen  were  performed  in  the  First  Division  Hospital,  the 
only  ones,  to  my  knowledge,  during  the  Cuban  Campaign. 
All  of  the  patients  died.  This  unfavorable  experience  should 
not  deter  surgeons  from  performing  the  operation  in  the  future 
in  cases  in  which  from  the  course  of  the  bullet  it  is  reasonable 
to  assume  that  the  bullet  has  made  visceral  injuries  which 
would  be  sure  to  destroy  life  without  surgical  interference. 


In  other  cases  the  employment  of  diagnostic  tests  for  the  pur- 
pose Oi  demonstrating  the  existence  or  absence  of  intestinal 
perforations  will  enable  the  surgeon  to  decide  what  course  to 
pursue.  Abdominal  section  is  always  justifiable  in  cases  of 
internal  hemorrhage  sufficient  in  amount  to  threaten  life. 

A  number  of  cases  of  gunshot  wounds  of  the  abdomen  have 
been  related  in  connection  with  gunshot  injuries  of  the  neck 
and  chest,  in  which  the  cavity  of  the  chest  and  abdomen  and 
their  contents  were  implicated  at  the  same  time,  and  which 
are  on  the  way  to  recovery  without  laparotomy  having  been 


177 


performed.      I   have  seen  a  number  of  cases  of  perforating 
wounds  of  the  abdomen  in  the  First  and  Third  Division  Hos- 


Fiff.  2T>R. 
pitals  that  were  on  a  fair  way  to  recovery  without  operation 
before  they  were  sent  home  on  transport  ships.     In  most  of 
these  instances  the  bullet  wounds  were  either  in  the  umbilical 


178 


region  or  one  of  the  iliac  fosste.      The  following  case  presents 
features  of  more  than  usual  clinical  and  surgical  interest : 

Case  22. — J.  F.  Taylor,  Company  D,  Tenth  Cavalry,  was 
wounded  July  2.      At  the  time  the  injury  was  received  he  was 


\ 


Fif?.  25b. 
in  the  ventral  prone  position.  The  bullet  entered  the  left 
shoulder  in  the  infraspinatus  fossa  one  inch  below  the  spinous 
process  of  the  scapula,  and  passed  downward  and  inward  and 
lodged  under  the  skin  in  the  median  line,  two  inches  above  the 
umbilicus  (Pig.  25).  Hemoptysis  considerable  during  the  first 
day,  when  it  gradually  subsided.    He  complained  of  great  pain 


179 


and  tenderness  in  the  right  side  of  the  abdomen.  No  vomiting 
or  symptoms  of  more  than  a  circumscribed  peritonitis.  An 
abscess  formed  in  the  abdominal  wall,  which  was  opened  July 
20,  and  the  bullet  was  removed.  From  this  time  on  the  pati- 
ent improved  rapidly. 


K 


GUNSHOT    WOUNDS    OF    THE   EXTREMITIES. 

It  is  a  source  of  gratification  to  know  that  very  few  primary 
amputations  were  made  for  gunshot  injury  of  the  extremities. 
All  of  the  surgeons  realized  the  importance  of  conservative 
measures  in  the  treatment  of  such  injuries,  and  limited  ampu- 


180 


tation  to  cases  in  which  the  condition  of  the  soft  tissues  pre- 
cluded such  a  course.  A  number  of  secondary  amputations 
became  necessary  to  save  life  in  cases  of  infected  compound 
fractures,  usually  complicated  with  injury  and  infection  of  the 
adjacent  joint.     Two  cases  of  traumatic  aneurysm  are  now  on 


// 


Fiff,  26b. 
board  the  Relief,  one  an  aneurysmal  varix,  the  other  an  aneur- 
ysm of  the  femoral  artery. 

Case  -25. —  Captain  Mosher,  Company  G,  Twenty-second 
Infantry,  received  a  bullet  wound  July  1,  during  the  advance 
on  Santiago.  Those  who  saw  the  patient  first  assert  that  the 
hemorrhage  was  severe,  and  that  the  patient  lost  conscious- 


I 


181 


ness.  He  was  removed  to  the  First  Division  Hospital  and 
transferred  July  10  to  the  Third  Division  Hospital,  and  the 
following  day  he  was  brought  on  board  the  Relief.  I  exam- 
ined the  patient  at  the  front  five  days  after  the  injury  and  con- 
firmed the  diagnosis  made  by  the  attending  surgeons,  who  had 
recognized  the  anatomic  nature  of  the  aneurysm. 

The  wounds  healed  by  primary  intention  in  less  than  two 
weeks.  One  wound  is  in  the  middle  of  Scarpa's  triangle  and 
the  other  at  the  level  of,  and  one  inch  posterior  to  the  great 
trochanter  on  the  same  side.  From  the  fact  that  there  is,  as 
shown  by  the  radiograph,  a  piece  of  the  jacket  of  a  bullet  in 
the  right  popliteal  space,  it  is  probable  that  he  was  wounded 
by  a  plunging  fire  and  that  the  bullet  inflicted  the  latter  wound 
after  emerging  from  the  wound  in  Scarpa's  triangle.  The 
wound  in  the  popliteal  space  is  suppurating.  Patient  is  very 
anemic  and  weak.  In  the  triangle  directly  under  the  wound 
there  is  a  pulsating  swelling  in  the  direction  of  the  femoral 
vein,  which  extends  to  Poupart's  ligament.  Fremitus  and  the 
characteristic  bruit  extend  a  considerable  distance  above  and 
below  the  communicating  opening  between  the  artery  and  vein. 
The  treatment  consists  in  rest  and  tonics.  General  health  of 
the  patient  is  improving,  but  there  is  no  change  in  the  local 
condition.  The  mental  condition  much  impaired  since  the 
injury  is  gradually  improving. 

Case  24. — John  J.  Welch,  Company  M,  Second  Massachu- 
setts Volunteers,  was  wounded  July  1.  The  bullet  entered 
the  middle  and  back  of  Scarpa's  triangle,  three  inches  below 
Poupart's  ligament,  directly  over  the  femoral  artery,  and 
escaped  at  a  point  corresponding  with  the  gluteal  crease  and 
to  the  outside  of  the  femur  on  the  same  side  (Figure  26). 
Not  much  hemorrhage.  A  well-marked  aneurysm  developed, 
presenting  all  the  physical  signs  characteristic  of  such  a  path- 
ologic condition.  The  swelling  is  somewhat  elongated,  a  little 
larger  than  a  hen's  egg,  and  has.  not  increased  in  size  since  the 
patient  came  on  board  the  hospital  ship.  The  leg  is  somewhat 
edematous  and  painful.  A  number  of  gunshot  fractures  of 
the  thigh  and  leg  have  become  infected  and  are  now  being 
treated  by  establishing  free  tubular  drainage  and  resorting  to 
frequent  or  continuous  antiseptic  irrigation.  Owing  to  the 
want  of  reliable  plaster  of  Paris,  we  had  to  resort  to  various 


182 


kinds  of  splints,  single  and  double  inclined  plane,  in  effecting 
immobilization.  The  sheath  of  the  leaf  of  the  cocoa  palm  has 
served  as  an  excellent  material  for  this  purpose.  There  is 
every  prospect  that  most  of  these  cases  will  utimately  recover 
with  useful  limbs. 

In  conclusion  I  desire  to  thank  Acting  Assistant-Surgeons 
Metcalfe,  Torney,  Greenleaf,  Hartsock,  Morrow  and  Schultze 
for  valuable  assistance  in  preparing  this  communication. 


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Wiuu  our  iroupH  cuuxu   uut    lan   lu    atartiug    auu    uisaetuiuctting 


THE  SURGERY  OF  CAMP  WIKOFF 


The  great  national  Camp  Wikoff  has  been  made  the  recip- 
ient of  the  returning  army  of  Cuba.  Three  months  ago  the 
invasion  of  Cuba  was  ordered.  Our  troops  left  the  different 
camps  in  excellent  condition  and  good  cheer  to  meet  the  Span- 
ish army  in  the  neighboring  island,  fully  informed  and  impressed 
with  the  events  that  awaited  them.  The  army  of  invasion 
considered  it  a  privilege  to  be  called  to  the  front  to  represent 
the  military  prowess  and  power  of  this  country.  The  outside 
world  had  no  conception  of  what  our  army  could  accomplish  at 
such  short  notice  in  a  distant  tropical  country.  The  authori- 
ties, and  particularly  the  medical  department,  were  fully 
aware  of  the  fact  that  the  invasion  of  Cuba  meant  more  a 
battle  with  climate  and  disease  than  the  weakened,  sickly, 
half  starved  Spanish  forces.  The  invasion  was  planned  on  the 
spur  of  the  moment,  and  the  corps  were  rushed  to  the  front  with 
a  haste  that  appeared  all  out  of  proportion  to  the  conditions  of 
things  as  they  presented  themselves  at  the  seat  of  war.  It  was 
decided  that  our  flag  should  float  over  the  city  of  Santiago  on 
the  Fourth  of  July  regardless  of  consequences.  The  army  of 
invasion  was  packed  on  transports  days  before  the  final  order 
was  given  to  sail.  Here  was  one  of  the  many  causes  that 
impaired  the  health  of  our  troops.  The  lack  of  harbor  facili- 
ties on  the  coast  of  Cuba,  where  our  army  landed,  made  dis- 
embarkment  and  the  landing  of  supplies  exceedingly  difficult. 
Most  of  the  barges  intended  for  this  purpose  were  wrecked 
during  the  voyage,  a  serious  loss  which  could  not  be  remedied 
in  time.  Much  suffering  was  caused  by  the  lack  of  efficient 
landing  and  transportation  facilities.  Our  troops  were  sup- 
plied with  rations  calculated  for  our  climate,  but  not  adapted 
for  a  tropical  country.  Our  soldiers  were  exposed  at  once  to 
malarial  infection  in  all  of  the  camps.  Occupation  of  the 
buildings  in  which  yellow  fever  had  full  sway  for  years,  and 
the  free  intermingling  of  the  filthy  Cuban  refugees  and  soldiers 
with  our  troops  could  not  fail  in  starting  and  disseminating 


184 


this  disease  among  our  soldiers  soon  after  landing  on  Cuban 
soil.  Typhoid  fever,  which  prevailed  in  all  of  our  large  camps 
before  the  army  sailed  for  Cuba,  soon  gained  a  firm  foothold 
at  the  seat  of  war  and  did  its  share  in  increasing  the  mortality 
and  in  shattering  the  efficiency  of  the  service.  Amebic 
dysentery  and  diarrhea,  the  two  greatest  enemies  of  the  Span- 
ish army,  thinned  out  our  ranks  and  crowded  our  imperfectly 
equipped  hospitals.  It  was  fortunate  that  the  enemy  yielded 
to  our  arms  so  early,  and  made  it  possible  for  our  troops  to 
return  so  soon  to  the  invigorating  climate  of  the  North  for 
proper  care  and  speedy  recuperation.  Those  who  saw  the 
different  regiments  leave  our  State  and  national  camps  would 
find  it  difficult  to  recognize  and  identify  the  soldiers  of  the 
Cuban  campaign.  The  men  left  in  excellent  spirits.  Most  of 
them  return  as  mere  shadows  of  their  former  selves.  The  pale 
faces,  the  sunken  eyes,  the  staggering  gait  and  the  emaciated 
forms  show  only  too  plainly  the  effects  of  climate  and  disease. 
Many  of  them  are  wrecks  for  life,  others  are  candidates  for  a 
premature  grave,  and  hundreds  will  require  the  most  careful 
attention  and  treatment  before  they  regain  the  vigor  they  lost 
in  Cuba.  The  surgery  of  Camp  Wikoff  represents  cases  and 
pathologic  conditions  which  we  would  expect  to  occur  in  men 
suffering  from  the  effects  of  disease,  exposure  and  the  debili- 
tating effects  of  a  tropical  climate.  Our  work  has  consisted 
largely  in  the  treatment  of  abscesses  and  operations  for  fistula 
ani  and  hemorrhoids.  I  was  ordered  to  Camp  Wikoff  on  my 
return  from  Porto  Kico,  and  reported  for  duty  August  22.  The 
field  operating  tent  and  surgical  wards,  already  in  construc- 
tion, were  completed  in  two  days.  I  have  been  assisted  in  my 
surgical  work  by  Major  Charles  Adams,  U.  S.  V.,  and  Acting 
Assistant-Surgeon  Henry  Greenleaf.  The  Sisters  of  Charity 
have  charge  of  the  surgical  wards,  and  two  of  them  make  the 
necessary  preparations  for  operation  and  assist  in  the  operat- 
ing tent. 

SURGICAL    HOSPITAL. 

The  surgical  hospital  at  Camp  Wikoff  is  a  part  of  the  gen- 
eral hospital.  It  consists  of  nine  wall  tents,  placed  end-to-end 
and  supported  by  a  substantial  wooden  frame  and  floored 
throughout,  constituting  a  pavilion  of  126  x  li  feet  in  extent. 
The  front  tent,  Xo.  1,  facing  southeast,  boarded  at  the  sides, 


185 


with  a  broad  table  shelf  on  either  hand,  is  used  as  an  operat- 
ing tent.  It  is  equipped  with  a  regulation  operating  table, 
iron  frame  and  top.  Sterilized  dressings,  gauze  sponges,  liga- 
tures, etc.,  are  kept  in  steriFized  towels  in  readiness  for  use  at 


Major  Hkitzmakx,  Surgeon  U.S.A. 

any  moment.  The  shelves  and  tables  are  covered  with  white 
rubber  cloth,  which  is  kept  scrupulously  clean.  The  instru- 
ments, after  sterilization,  are  kept  in  trays  containing  a  2  per 


186 


cent,  solution  of  carbolic  acid.  Saline  and  antiseptic  solutions 
are  kept  ready  for  use  in  four-gallon  bottles.  All  surgical 
paraphernalia  not  in  use  are  covered  by  clean  white  sheets. 
The  second  tent,  open  at  the  sides  for  free  ventilation  and  cool- 
ness, is  used  for  the  office  of  the  surgeon  in  charge.  It  is  sup- 
plied with  a  field  desk,  table  and  chairs.  Section  No.  3  is  the 
preparation  room.  The  instruments  are  kept  here  under  lock 
and  key.  Two  sterilizers,  basins,  buckets,  pitchers  and  a  table 
constitute  the  equipment  of  this  room.  A  glass  irrigator  and  a 
number  of  fountain  syringes  furnish  the  facilities  for  irrigation. 
A  field  operating  case,  a  Paquelin  cautery,  a  full  set  of  dental 
forceps,  a  complete  set  of  urethral  instruments,  a  case  of  eye 
and  ear  instruments  and  aspirator  have  furnished  all  the  instru- 
ments required.  The  instruments  are  sterilized  by  boiling, 
the  dressings  by  dry  heat. 

Hand  disinfection  consists  in  scrubbing  for  at  least  five  min- 
utes in  hot  water  and  potash  soap,  washing  in  absolute  alcohol 
followed  by  prolonged  immersion  in  a  1-1000  solution  of  bichlo- 
rid.  Just  before  the  operation  is  commenced  the  hands  are 
washed  once  more  in  alcohol.  The  field  of  operation  is  disin- 
fected in  the  same  manner  as  the  hands.  Section  5  answers  the 
purpose  of  a  pantry  and  kitchen  for  special  diet.  From  here 
the  distribution  of  food  takes  place  as  it  is  received  from  the 
main  kitchen  of  the  hospital.  Between  the  supply  tent  and 
the  pantry  is  an  open  passage-way  four  feet  wide,  through 
which  the  patients  and  nurses  enter  and  leave  the  hospital. 
The  four  tents  remaining  are  used  for  wards,  having  a  capacity 
of  32  beds.  This  hospital  in  the  course  of  a  few  days  was  filled, 
when  ward  A,  adjacent,  occupied  by  medical  cases,  was  evacu- 
ated to  make  room  for  surgical  cases.  The  present  arrange- 
ments affords  room  for  seventy-five  surgical  patients.  At  the 
present  time,  September  10,  every  bed  is  occupied.  The  six 
Sisters  of  Charity  in  charge  are  assisted  by  three  orderlies  from 
the  Hospital  corps.  Patients  are  prepared  for  operations  with 
proper  antiseptic  precautions,  and  no  pains  are  spared  to  give 
them  the  benefit  of  modern  surgical  methods  in  every  detail, 
during  their  stay  in  the  hospital.  The  nursing  and  care  of  the 
sick  are  faultless,  and  the  diet  is  not  only  ample  in  quantity 
and  quality,  but  often  luxurious,  far  exceeding  what  is  served 
on  the  table  of  the  officers  mess  tent.     The  patients  much  re- 


189 


with  cotton  saturated  with  carbolic  acid,  but  in  the  majority 
of  cases  the  patients  returned  and  insisted  on  having  the  pain- 
ful tooth  extracted.  Tooth  extraction  was  a  conspicuous  and 
grateful  part  of  the  surgery  of  Camp  Wikotf.  Hardly  a  day 
passed  without  two  or  three  such  operations.  A  very  complete 
set  of  tooth  forceps  furnished  by  the  government  did  good  ser- 
vice in  relieving  the  victims  of  toothache  of  their  agonizing  suf- 
fering. Much  has  been  said  in  favor  of  attaching  a  dentist  to 
each  regiment  to  look  after  the  teeth  of  the  men,  and  the  ob- 
servations made  in  Camp  Wykoff  tend  to  support  the  propriety 
of  such  a  much-needed  addition  to  the  medical  service.  It  is 
interesting  to  know  that  among  these  patients  there  was  not  a 
single  officer,  undoubtedly  because  the  officers  were  more  par- 
ticular in  the  care  of  their  teeth  than  the  privates, 

HERNIA. 

The  number  of  hernias  that  presented  themselves  in  Camp 
Wikoff  astonished  us  all.  In  every  case  the  statements  of  the 
patients  were  to  the  effect  that  the  hernia  appeared  since  the 
enlistment.  It  might  be  surmised  that  at  least  in  some  of  the 
cases  this  physical  defect  was  overlooked  during  the  examina- 
tion. This  might  have  been  so  in  isolated  instances,  in  the 
case  of  volunteers,  but  such  a  view  would  not  hold  good  in  men 
belonging  to  the  regular  army.  I  saw  more^  cases  of  hernia  in 
men  belonging  to  the  latter,  than  the  former  branch  of  the 
military  service.  Our  army  in  Cuba  was  not  subjected  for  any 
length  of  time  to  hard  marching  or  violent  exertions  of  any 
kind,  consequently  the  causes  which  led  to  hernia  must  be 
sought  outside  of  such  mechanical  influences.  Careful  exam- 
ination appeared  to  prove  that  in  most,  if  not  in  all  cases,  the 
hernia  was  of  recent  origin.  I  attribute  the  hernia-formation 
principally  to  the  relaxation  of  tissue,  caused  by  disease  and 
its  effects,  aided  undoubtedly  by  the  prevalence  of  intestinal 
affections  which  must  have  often  resulted  in  increased  abnor- 
mal intra  abdominal  tension.  The  uncertainty  of  the  duration 
of  the  encampment  induced  me  to  advise  against  operative  in- 
terference, and  in  most  cases  the  general  condition  of  the  pa- 
tients was  such  as  to  constitute  in  itself  a  strong  contraindica- 
tion to  the  performance  of  a  radical  operation.  The  patients 
were  fitted  with  a  truss  and  advised  to  have  a  radical  operation 


190 


performed  after  their  general  health  was  restored,   after  leav- 
ing the  service  or  obtaining  a  furlough. 

VARICOCELE. 

The  frequency  with  which  varicocele  is  met  with  in  men  from 
18  to  1.5  years  was  shown  in  the  examination  of  9901  volunteers 
in  Camp  Tanner,  Illinois.  As  a  member  of  the  board  of  exam- 
iners, I  was  very  anxious  to  obtain  accurate  information  regard- 
ing this  subject,  and  accurate  notes  were  kept  at  the  time. 
We  found  varicocele,  slight,  992  ;  medium,  692  ;  large,  295.  Of 
the  slight  cases  10  were  double,  7  of  the  right  side  only  ;  of  the 
medium  cases,  7  were  double,  and  4  of  the  right  side  only ;  of 
the  large  cases  4  were  of  the  right  side  only.  The  percentage 
of  varicoceles  to  total  number  examined  was  21.17,  Only  six 
were  regarded  as  physical  disabilities,  and  those  on  account  of 
size  and  pain.  At  that  time  I  wrote  a  paper  calling  attention 
to  the  great  frequency  of  varicocele  in  men  of  the  age  for  mili- 
tary service,  and  claimed  that  ordinary  varicocele  was  no  valid 
objection  to  the  enlistment  of  men  for  military  duty.  Of  the 
more  than  15000  men  who  returned  from  Cuba  and  were 
landed  at  Montauk,  only  five  cases  of  variococele  applied  for 
treatment  at  the  surgical  ward.  In  all  of  these  cases  the  local 
symptoms  were  such  as  to  warrant  an  operation.  The  opera- 
tion was  performed  by  excising  through  a  straight  incision, 
directly  over  the  cord,  the  enlarged  veins  between  double  liga- 
tures. The  veins  were  carefully  isolated  by  dissection  from 
the  spermatic  cord  and  the  accompanying  artery.  After  excis- 
ion the  two  stumps  were  brought  together  by  a  single  catgut 
suture,  and  by  tying  over  this  a  thread  of  one  of  the  ligatures 
left  long  from  each  side.  The  stumps  were  buried  by  several 
fine  catgut  sutures  with  which  the  deep  layers  of  the  tissues 
were  united.  The  external  wound  was  always  closed  with 
horsehair  sutures.  Elongation  of  the  scrotum  sufficient  in  de- 
gree to  require  attention  was  corrected  by  transverse  suturing 
of  the  external  wound.  The  wound  was  sealed  with  collodium,  a 
few  narrow  strips  of  iodoform  gauze,  and  a  pledget  of  absorbent 
cotton  over  which  the  usual  dressing  and  bandage  were  applied. 

Case  1. — John  D.  Deboer,  aged  21,  colored ;  Troop  B,  First 
Cavalry  ;  has  had  varicocele  for  the  last  eighteen  months.  En- 
listed five  weeks  ago.  Marked  ectasia  of  the  spermatic  veins 
on  the  left  side  with  corresponding  elongation  of  scrotum  o© 


191 

same  side.  He  has  had  no  pain,  but  much  discomfort  in  hot 
weather  from  relaxation  and  dragging  sensation.  Operation 
under  chloroform  narcosis  August  31.  (Jeneral  health  not 
much  impaired. 

Case  v.— William  Cantwell,  age  31,  Company  B,  Sixteenth 
Infantry  ;  has  been  in  the  service  fourteen  years.  Varicocele 
appeared  eighteen  months  ago.  Since  he  entered  the  active 
service  the  swelling  has  often  been  painful,  especially  during 
forced  marches  and  in  hot  weather.  He  is  much  concerned 
about  his  condition,  and  submitted  willingly  to  the  operation, 
which  was  performed  under  ether  anesthesia  September  .3. 
On  exposing  the  varicose  veins  it  was  found  that  the  tunica 
vaginalis  had  remained  patent  from  the  external  inguinal  ring 
to  the  testicle,  but  contained  no  tluid.  The  veins  were  isolated 
with  some  difficulty  from  the  cord  and  the  spermatic  artery. 
After  disposing  of  the  vein  stumps  in  the  usual  way  the  tunica 
vaginalis  was  closed  with  fine  catgut  sutures  over  the  cord. 
The  scrotum  was  shortened  by  transverse  suturing  of  the 
wound. 

Case  o.—Wm.  Reed,  age  23,  colored  :  Troop  H,  Ninth  Cavalry. 
Made  its  appearance  soon  after  his  enlistment  two  months  ago. 
The  varicocele  is  of  large  size  and  gives  rise  to  much  pain  on 
riding  or  walking  any  distance.  Operation  under  chloroform 
narcosis  September  3. 

Case  4. — Robert  Duseman,  age  21,  Second  Volunteer  Engin- 
eers. Entered  the  service  two  months  ago.  Six  weeks  ago, 
during  drill,  he  bruised  the  left  side  of  the  scrotum,  and 
attributes  the  varicocele  to  this  cause.  He  complains  of  a 
dragging  sensation  in  the  testicle  on  the  left  side,  the  seat  of 
the  varicocele  of  medium  size.  Usual  operation  under  ether, 
September  11. 

In  all  of  these  cases  the  general  health  of  the  patients  was 
not  much  impaired,  and  the  wounds  healed  rapidly  by  primary 
intention. 

HYDROCELE, 

Hydrocele  from  puberty  to  the  age  of  45  occurs  much  less 
frequently  than  varicocele.  Of  the  9901  cases  examined  in 
Camp  Tanner,  we  found  only  49  cases  of  hydrocele  of  the 
tunica  vaginalis  and  18  of  the  cord.  Only  one  case  of  hydrocele 
of  the  tunica  vaginalis  came  for  treatment  to  the  surgical  ward 
of  Camp  Wikoflf. 

Case  J.— John  Craigie,  Company  E,  First  Artillery,  a  young 
soldier  whose  health  had  become  greatly  undermined  by  malaria, 
was  sent  from  the  medical  to  the  surgical  ward,  for  a  painful 
affection  of  the  left  testicle  of  a  few  days'  duration.  Patient 
very  anemic  and  emaciated.  A  few  days  ago,  on  recovering 
from  his  illness  for  which  he  had  been  sent  to  the  hospital,  the 


192 


left  testicle  became  painful  and  tender,  accompanied  by  a 
gradually  increasing  swelling.  He  came  under  surgical  treat- 
ment August  27.  Careful  examination  revealed  an  acute  hy- 
drocele of  the  tunica  vaginalis  on  the  left  side,  without  any 
palpable  visceral  lesions  of  the  testicle  or  epidydimis.  The 
fluid,  straw  colored,  was  evacuated  by  tapping  with  a  small 
trocar.  One  dram  of  equal  parts  of  alcohol  and  carbolic  acid 
was  injected.  The  reaction  was  moderate  and  the  patient  left 
a  few  days  later,  the  swelling  gradually  diminishing  in  size. 

BONES    AND   JOtN'TS. 

Only  a  few  cases  of  injury  and  disease  of  bones  and  joints 
came  under  observation  in  the  surgical  department  of  the 
general  hospital,  but  these  isolated  cases  present  features  of 
interest  sufficient  to  justify  mention  in  connection  with  the 
subject  of  this  communication. 

Case  6. — Gunshot  fracture  of  femur.  S.  M.  Wetmore, 
age  25,  trumpeter,  Troop  D,  First  Volunteer  Cavalry,  was 
shot  through  the  right  thigh  at  the  junction  of  the  lower  with 
the  middle  third,  the  bullet  passing  in  the  antero  posterior 
direction,  the  wound  of  exit  being  on  a  higher  level  than  the 
wound  of  entrance.  The  wounds  were  dressed  with  idoform 
and  healed  by  primary  intention.  Just  before  he  was  trans- 
ferred from  the  hospital  at  Siboney  to  the  Relief  he  became 
very  much  debilitated  and  manifested  other  and  more  charac- 
teristic symptoms  of  iodoform  intoxication.  A  plaster  cast 
was  applied,  and  he  was  sent  to  the  fever  camp  as  a  case  of 
yellow  fever— a  diagnosis  which  was  never  confirmed  by  the 
physicians  in  charge  of  the  hospital.  He  suffered  from  mala- 
ria, and  his  present  condition  indicates  to  what  extent  the 
malarial  intoxication  has  advanced.  He  is  extremely  anemic, 
and  emaciated  to  a  skeleton.  The  spleen  is  much  enlarged^ 
The  fractured  limb  is  shortened  two  inches  and  a  half  ;  marked 
overlapping  of  fragments ;  union  fibrous.  Plaster  of  Paris 
bandage  reapplied.     Tonic  and  stimulating  treatment. 

Ca^-e  7.  — R.  Whitington,  aged  25,  First  Volunteer  Cavalry, 
on  August  11  was  riding  bareback,  when  his  horse  made  a 
quick  turn  and  in  tumbling  over  an  embankment  the  horse 
fell  upon  his  left  leg,  producing  an  oblique  fracture  of  the 
tibia  about  two  inches  above  the  base  of  the  malleolus,  and  of 
the  fibula  about  four  inches  higher.  For  some  days  the  limb 
was  placed  in  a  fracture  box,  but  it  was  found  impossible  to 
immobilize  the  fragments  properly.  During  this  time  the 
patient  suffered  from  pain  and  loss  of  sleep.  August  27  he 
was  placed  under  the  influence  of  chloroform,  the  fragments 
were  properly  adjusted  and  the  limb  immobilized  in  a  plaster 
of  Paris  splint  extending  from  the  base  of  the  toes  to  the 
knee.  Since  that  time  he  has  been  free  from  pain  and  has 
slept  without  the  use  of  anodynes. 


193 

Case  8.— Maj.Cien.  S.  B.  M.  Young  injured  his  ankylosed 
elbow- joint,  September  2,  and  received  first  aid  at  the  surgi- 
cal ward  the  next  morning.  During  the  War  of  the  Rebellion 
he  received  two  gunshot  wounds  of  the  right  arm.  One  shat- 
tered the  lower  third  of  the  humerus,  the  other  perforated  the 
elbow  joint.  After  a  prolonged  siege  of  suppuration  he  finally 
recovered  with  ankylosis  of  the  elbow-joint,  in  flexion  at  an 
angle  of  about  110  degrees,  and  in  a  position  of  marked  pro- 
nation. September  1  he  stumbled  and  fell,  striking  upon  the 
hand  and  elbow.  He  complains  of  severe  pain  in  and  about 
the  joint.  The  elbow-joint  is  swollen  and  very  painful  on 
pressure  and  manipulation.  Ecchymosis  over  both  condyles. 
There  is  some  motion  but  no  crepitation,  indicating  the  exist- 
ence of  ruptured  intra  and  periarticular  adhesions.  The  patient 
states  that  this  is  the  fourth  time  since  the  ankylosis  occurred 
that  it  has  been  broken  by  injury  of  some  sort.  The  limb  was 
padded  with  a  thick  layer  of  cotton  from  the  base  of  the 
fingers  to  the  shoulder-joint,  over  which  a  light  plaster  of  Paris 
bandage  was  applied.  The  patient  was  placed  in  charge  of 
Major  Nancrede,  his  attending  physician,  who  a  few  days  later 
substituted  for  the  plaster  dressing  an  angular  wire  splint. 
In  less  than  a  week  he  reported  for  duty  at  Camp  Meade. 

Case  9.— Thomas  A.  McDonald,  age  24,  Second  Infantry. 
While  in  action  before  Santiago  the  stock  of  his  gun  was 
struck  by  the  fragment  of  a  shell,  the  arm  was  violently 
twisted  and  the  radius  fractured.  The  forearm  now  presents 
the  characteristic  "silver  fork"  deformity  of  an  imperfectly 
reduced  Colles'  fracture.  There  is  swelling  of  the  wrist,  ina- 
ability  to  use  fingers,  and  pain  on  attempted  pronation  and 
supination.     Massage,   manipulation  and  electricity  advised. 

Case  10. — Preston  Guthrie,  aged  31,  Company  F,  Twentieth 
Infantry,  re-enlisted  three  and  one-half  months  ago.  States 
that  he  cut  his  left  arm  two  years  ago.  The  wound  was  slow  in 
healing  and  left  a  scar  adherent  to  the  underlying  ulna. 
Nothing  in  the  clinical  history  would  indicate  that  the  bone 
was  affected  at  that  time.  A  contusion  of  same  region  occured 
while  loading  a  transport  in  Cuba,  which  was  followed  by  a 
complexus  of  symptoms  pointing  to  the  existence  of  a  central 
osteomyelitis.  An  abscess  which  formed  later  ruptured 
through  the  old  scar,  an  occurrence  which  was  followed  by 
prompt  relief.  A  moderate  discharge  has  continued  since. 
Examination  made  August  26  disclosed  two  fistulous  openings 
over  the  posterior  surface  and  center  of  the  ulna,  leading  into 
a  central  osteomyelitic  cavity.  Ulna  at  the  seat  of  disease  con- 
siderably enlarged.  Through  a  straight  incision  the  fistulous 
openings  in  the  involucrum  were  exposed  and  the  cavity  freely 
laid  open  by  chiselling.  A  sequestrum  lying  loosely  in  the 
bone  cavity  was  removed  and  the  granulations  lining  the 
cavity  scraped  out  by  a  vigorous  use  of  the  sharp  spoon. 
After  thorough  disinfection  of  the  cavity  the  periosteum  was 


194 

sutured  carefully,  over  which  the  wound  was  closed  in  the 
usual  manner,  leaving  only  a  small  space  for  gauze  drainage. 
The  wound  remained  aseptic  and  healed  rapidly  by  primary 
intention. 

Case  11. — George  Oppel,  aged  21,  enlisted  in  the  Second 
Infantry  one  month  ago.  He  was  admitted  to  the  surgical 
ward  with  a  fluctuating  swelling  over  the  inner  aspect  and  a 
little  above  the  left  knee  joint.  Ten  years  ago  he  was  struck 
in  this  region  with  a  brick  and  suffered  from  an  acute  bursitis. 
The  bursa  has  been  enlarged  ever  since,  but  has  not  been  pain- 
ful until  recently.  There  is  no  tubercular  history  in  his 
family.  The  swelling  is  flat  and  in  circumference  is  as  large 
as  a  medium  sized  orange.  On  palpation  no  fluctuations  can 
be  felt,  the  sensation  imparted  being  of  a  semi-elastic  nature. 
The  swelling  is  somewhat  tender  to  touch  and  is  painful  when 
he  attempts  to  walk.  August  31,  the  patient  being  under  the 
influence  of  a  general  anesthetic,  the  bursa  was  punctured 
with  a  small  trocar  in  three  different  directions  through  the 
same  opening  in  the  skin  and  was  thoroughly  injected  with  a  5 
per  cent,  solution  of  carbolic  acid.  Pressure  was  applied  over 
the  bursa  and  the  limb  immobilized  upon  a  posterior  splint. 
In  the  course  of  a  week  the  swelling  had  almost  entirely  disap- 
peared and  the  patient  returned  to  his  command  for  duty. 

REMOVAL    OF    ^OREIG^'    BODIES. 

Two  interesting  cases  of  removal  of  a  foreign  body  lodged  in 
the  tissues  presented  themselves  for  operative  treatment. 

Case  i^.— Benjamin  Nelson,  age  23,  Company  F,  Third 
Infantry.  Came  under  observation  and  treatment  September 
6.  Three  years  ago  he  fell  backward  against  a  window  and 
sustained  several  cuts  of  the  scalp  by  fragments  of  broken 
glass.  The  wounds  healed  rapidly  without  suppuration. 
After  his  recovery  he  was  aware  of  the  presence  of  a  piece  of 
glass  which  had  remained  encysted  in  the  pericranial  tissues 
ever  since,  without  giving  rise  to  any  inconvenience  until 
recently.  A  few  weeks  ago  the  scalp  over  the  embedded 
foreign  body  was  bruised,  and  since  that  time  it  has  caused 
irritation  and  pain.  The  piece  of  glass  could  be  readily 
outlined  by  palpation.  On  the  day  mentioned,  without  anes- 
thesia, a  straight  incision  parallel  to  the  long  axis  of  the 
foreign  body  was  made.  Xo  suppuration  within  or  outside  of 
the  capsule.  The  piece  of  glass  was  found  surrounded  by  a 
firm  capsule  of  fibrous  tisue  and  measured  two  centimeters  in 
length  and  two  tenths  of  a  centimeter  square  at  the  end.  The 
broken  surface  was  irregular  in  outline.  The  wound  was 
sutured  with  horsehair  and  union  was  found  complete  at  the 
time  of  his  discharge,  September  11. 

Case  75.— Sergt.  Oscar  F.  Winter,  age  52,  Company  F, 
Ninth  Infantry,  seventeen  years  in  service.     On  July  2,  while 


195 

in  the  act  of  risiDg  just  behind  the  trenches,  he  was  wounded 
by  the  bursting  of  a  shell  near  him.  He  was  confident  at  the 
time,  from  the  sensation  experienced,  that  he  had  received  a 
blow  from  a  large  fragment  of  shell  on  the  crest  of  the  left 
ilium.  He  says  a  large  ecchymosis  formed  at  once  and  he 
could  see  no  evidence  of  penetration.  He  was  assured  by  a 
medical  officer  that  he  had  suffered  a  contusion  only,  that 
there  had  been  no  penetration.  He  says,  however,  on  being 
questioned,  that  a  small  rent  existed  in  the  clothing  over  the 
supposed  contusion,  but  is  very  positive  that  he  must  have 
been  struck  by  the  convex  side  of  a  large  piece  of  the  burst- 
ing shell.  An  abscess  developed  soon  after  the  injury  was 
received  and  has  discharged  at  a  point  near  the  anterior 
superior  spine  of  the  ilium  and  the  resulting  sinus  has 
remained  since.  The  patient  has  done  duty  without  missing 
a  day  since  he  received  the  wound,  until  reaching  Camp 
Wikoff.  The  existence  of  an  abscess  cavity  and  the  history  of 
an  opening  in  the  clothing  led  to  exploration  for  a  foreign  body. 
The  existing  opening  was  slightly  enlarged,  under  chloroform 
anesthesia,  and  exploration  of  the  cavity  with  the  finger  located 
a  shrapnell  ball  at  about  3^^  inches  downward  from  the  open- 
ing of  the  sinus.  Counter-opening  was  made  at  this  point  and 
the  ball  extracted.  Tubular  drainage,  irrigation  with  peroxid 
of  hydrogen  and  21.3  percent,  carbolic  solutions  and  moist  car- 
bolic dressing.     Speedy  healing  of  the  wounds. 

ABSCESSES. 

We  would  naturally  take  it  for  granted  that  among  the  re- 
turning soldiers  from  Cuba,  owing  to  their  greatly  debilitated 
condition,  suppurative  affections  in  different  forms,  and  affec- 
ting various  tissues  and  organs,  would  furnish  a  rich  and  inter- 
esting material  for  the  surgical  ward  of  the  General  Hospital. 
The  sources  of  infection  were  many,  and  the  resistance  of  the 
tissues  to  pathogenic  microbes  in  most  of  the  men  who  returned 
was  at  low  ebb.  A  good  share  of  the  surgical  work  consisted 
in  incising  and  draining  abscesses,  some  of  them  of  enormous 
size.  In  the  treatment  of  all  of  these  cases,  owing  to  the  pro- 
nounced anemia  and  great  weakness,  special  precautions  were 
resorted  to  to  prevent  the  loss  of  even  as  much  as  a  teaspoon- 
ful  of  blood  in  performing  the  operations.  In  abscesses  in  the 
anal  region  the  Paquelin  cautery  was  usually  used  in  prefer- 
ence to  the  knife,  in  laying  open  the  abscess  cavity.  In  other 
regions  the  abscess  was  opened  by  making  an  incision  through 
the  skin  and  underlying  fascia  large  enough  to  admit  the  tip 
of  the  little  finger,  when  the  remaining  tissues  were  tunneled 


19H 

with  a  pair  of  curved,  rather  sharp  pointed  forceps,  and  the 
tubular  wound  enlarged  to  the  requisite  extent  by  expanding 
the  blades  of  the  forceps  during  the  withdrawal  of  the  instru- 
ment. In  most  instances  a  counter-opening  was  made  by 
plunging  the  forceps  into  the  abscess  cavity,  inserted  into  the 
first  opening,  through  the  tissues  from  within  outward  until 
the  tip  of  the  instrument  made  a  cone  of  the  skin  which  was 
then  incised,  not  over,  but  on  the  side  of  the  instrument,  suffi- 
ciently to  permit  the  easy  escape  of  the  instrument  when  the 
canal  was  enlarged  by  expanding  the  blades,  after  which  the 
end  of  the  drain  was  grasped  transversly  and  by  withdrawing 
the  instrument  through  drainage  was  established.  The  drains 
used  were  freely  fenestrated,  the  openings  being  numerous,  but 
never  larger  than  to  correspond  in  size  to  one-fourth  of  the  cir- 
cumference of  the  tube.  The  opening  and  counter-opening 
were  made  in  places  where  drainage  and  irrigation  would  prove 
most  efficient.  In  several  cases  in  which  the  counter-opening 
could  not  be  made  by  the  use  of  the  forceps,  the  abscess  was 
opened  in  the  usual  way,  and  after  evacuation  of  its  contents 
peroxid  of  hydrogen  was  injected  until  the  cavity  was  well  dis- 
tended, when  the  second  opening  was  made  in  the  same  way 
as  the  first.  After  opening  and  draining  the  abscess,  irriga- 
tion with  a  21.,  per  cent,  solution  of  carbolic  acid,  followed  by 
peroxid  of  hydrogen,  and  finally  again  with  the  carbolized 
solution.  In  all  abscess  cases  the  dressing  consisted  of  a  com- 
press of  gauze  wrung  out  of  a  2i.,  per  cent,  solution  of  carbolic 
acid,  over  which  oiled  silk  was  applied  with  absorbent  cotton 
around  its  edges,  to  act  as  a  filter,  and  the  whole  confined  in 
place  by  a  well-applied  bandage.  In  the  more  serious  cases 
the  dressing  was  removed,  the  abscess  cavity  flushed,  and  a 
new  compress  applied  twice  daily.  Whenever  it  was  deemed 
necessary,  the  affected  limb  was  immobilized.  This  treatment 
proved  uniformly  successful  in  preventing  profuse  suppuration 
and  was  always  followed  by  rapid  improvement  in  the  general 
condition  of  the  patient. 

In  the  medical  treatment  of  these  cases  quinin  was  used 
freely,  as  well  as  alcoholic  stimulants.  Iron  preparations  and 
a  nutritious  diet  proved  most  effectual  in  improving  the  con- 
dition of  the  impoverished  blood  and  in  restoring  normal 
nutrition. 


197 


CONNECTIVE  TISSUE  ABSCESSES. 

The  connective  tissue  was  the  tissue  most  frequently 
the  primary  or  secondary  seat  of  infection.  The  phlegmo- 
nous inflammation  which  led  to  connective  tissue  abscesses 
occurred  almost  exclusively  in  men  whose  general  health 
was  shattered.  As  a  rule  the  patients  suffering  from 
this  affection  presented  an  anemic,  almost  waxy  appear- 
ance and  were  greatly  emaciated.  The  deterioration  of 
health  was  due  to  antecedent  causes,  malaria,  yellow  fever, 
dysentery,  diarrhea,  exposure  and  improper  or  insufficient  food. 
The  phlegmonous  inflammation  in  most  instances  pursued  a 
rather  insidious  process  and  was  clinically  not  characterized 
by  the  complexus  of  symptoms  which  ordinarily  accompany 
the  inflammation  preceding  an  acute  abscess.  The  pain  was 
often  slight,  tenderness  moderate,  and  the  skin  seldom  showed 
the  inflammatory  blush  which  so  constantly  is  seen  during  the 
development  of  an  acute  subcutuneous  abscess.  A  tendency 
to  burrowing  was  manifest  in  most  cases.  The  induration  of 
the  abscess  wall,  so  common  in  acute  abscess,  was  lacking  in 
most  of  our  cases.  There  seemed  to  be  a  total  absence  of  a 
tendency  to  the  limitation  of  the  area  of  abscess  formation. 
The  cases  that  came  under  our  observation  resembled  in  their 
symptomatology,  pathology  and  clinical  course  very  closely 
abscess  formation  as  seen  during  the  latter  course  of  any  pro- 
longed acute  infective  disease,  or  during  convalescence  from 
such.  In  opening  these  abscesses  I  was  always  careful  to 
make  the  openings  some  distance  from  the  center  of  the  ab- 
scess cavity,  in  preference  at  its  margins,  and  the  same  loca- 
tion was  selected  in  case  a  counter-opening  was  made.  By  fol- 
lowing this  method  of  incising  and  draining  the  abscess  the 
skin  over  the  center  of  the  abscess,  damaged  to  the  greatest 
extent  by  the  underlying  phlegmonous  process  was  avoided, 
and  complete  evacuation  and  free  drainage  secured.  The 
same  careful  preparations  were  made  for  the  operation  as  in 
cases  requiring  surgical  intervention  for  aseptic  conditions, 
with  a  view  of  guarding  against  secondary  infection. 

Under  this  treatment,  the  general  and  local  conditions  of  the 
patients  improved  very  rapidly.  In  abscesses  of  very  large  di- 
mensions from  two  to  four  incisions  were  made  and  as  many 
points  of  drainage  established.  As  suppuration  ceased  and  the 


198 


abscess  cavity  commenced  to  shrink,  the  drains  were  shortened 
from  time  to  time  to  enable  the  process  of  healing  to  proceed 
without  hindrance  from  mechanical  causes. 

Case  ii.— Robert  Bloedel,  age  25,  Third  Infantry  Band, 
enlisted  fifteen  months  ago.  Had  chills  and  fever  in  Cuba  for 
about  a  month,  followed  by  dysentery.  Is  still  suffering  from 
the  diarrhea  which  followed  the  dysentery  and  the  patient  is 
much  emaciated  and  very  anemic.  Before  going  to  Cuba  he 
noticed  a  small  pimple  on  his  neck.  Just  before  leaving  San- 
tiago, swelling  of  the  neck  began  in  the  connective  tissue,  at 
the  site  of  the  pimple,  and  has  progressed  steadily.  Examina- 
tion of  the  cavity  of  the  mouth  does  not  reveal  a  source  of 
infection.  There  can  be  but  little  doubt  that  the  minute 
furuncle,  which  proved  harmless  as  long  as  the  patient  re- 
mained in  good  health,  became  the  focus  of  infection  of  the 
underlying  connective  tissue  which  was  made  more  susceptible 
to  infection  by  the  effects  of  disease.  A  large  fluctuating 
swelling  in  the  neck,  just  below  the  angle  of  the  jaw,  marks 
the  location  and  extent  of  the  connective  tissue  abscess.  Pain 
has  never  been  severe.  Edema,  but  no  redness  of  skin.  All 
of  the  local  symptoms  indicate  a  slow,  subacute  inflammation 
of  the  deep  connective  tissue.  The  patient  was  etherized  and 
through  drainage  was  established,  the  drainage  tube  being 
placed  in  an  oblique  direction  from  the  floor  of  the  abscess  to 
a  point  opposite  and  behind.  A  large  quantity  of  creamy  pus 
was  evacuated  and  the  cavity  thoroughly  washed  out  with  car- 
bolized  solution  and  peroxid  of  hydrogen.  A  large  moist  anti- 
septic compress  covered  with  oiled  silk  was  applied  and  held  in 
place  by  a  bandage.  Very  little  suppuration  after  operation, 
speedy  healing  of  the  abscess  cavity  accompanied  by  a  marked 
improvement  in  the  appearance  of  the  patient. 

Case  15. — P.  P.  Sprague,  age  29,  Seventh  Infantry,  Company 
I,  entered  the  regular  service  seven  months  ago.  He  landed  in 
Cuba  July  10.  Contracted  malaria,  lost  flesh  and  strength, 
but  continued  to  perform  his  usual  duties.  About  three  weeks 
ago  he  experienced  a  sense  of  soreness  in  the  calf  of  his  right 
leg  in  the  region  of  a  scar  from  an  injury  received  during  child- 
hood. The  soreness  increased  slowly  in  severity,  and  for  a 
number  of  days  he  has  suffered  from  a  throbbing  pain  suSi- 
ciently  severe  to  prevent  sleep.  The  patient  is  much  enfeebled 
from  the  effects  of  the  previous  disease,  aggravated  by  the 
recent  attack  of  phlegmonous  inflammation.  No  local  source 
of  infection  could  be  found  on  the  most  careful  search.  It  is 
very  probable  that  the  scar  tissue  furnished  the  locus  minoris 
resistentia'  which  determined  localization  of  pus  microbes 
floating  in  the  general  circulation  sufficient  in  number  and 
virulence  to  give  rise  to  a  subacute  phlegmonous  process.  The 
whole  leg  is  swollen  from  the  ankle  to  the  knee,  tense  and 
edematous,   a    circumscribed  inflammatory  blush    over    the 


199 

lower  portion  of  the  gastrocaemius  muscle.  Fluctuation 
deep  seated,  somewhat  obscure  and  diffuse. 

The  diagnosis  made  at  the  time,  was  deep-seated  phlegmonous 
abscess,  involving  the  connective  tissues  between  the  deep- 
seated  muscles  of  the  leg.  August  29,  under  ether  unesthesia 
the  abscess  was  opened  by  an  incision  over  the  posterior  aspect 
of  the  leg  in  the  median  line,  at  a  point  where  the  muscle  ter- 
minates in  tendon  ;  a  large  quantity  of  thin  bloody  pus  escaped. 
As  it  was  found  impossible  to  make  a  counter  opening  in  the 
upper  recess  of  the  abscess  cavity  by  the  use  of  forceps,  per- 
oxid  of  hydrogen  was  injected  through  the  opening  to  distend 
the  abscess  cavity  sufficiently  to  facilitate  incision  from  with- 
out. The  second  incision  was  made  in  the  usual  way  over  the 
upper  third  of  the  fibula  and  a  counter  opening  established  on 
the  tibial  side,  effecting  in  this  manner  efficient  through  drain- 
age below  and  from  side  to  side.  Digital  exploration  through 
the  three  openings  located  the  abscess  correctly  anatomically. 
In  exploring  the  interior  of  the  abscess  the  tibia  and  fibula 
could  be  distinctly  felt.  The  abscess  cavity  was  disinfected  in 
the  usual  way  and  after  applying  the  wet  antiseptic  compress, 
the  patient  was  returned  to  his  cot  and  the  limb  placed  in  an 
elevated  position.  The  final  recovery  of  the  patient  was 
retarded  by  several  severe  attacks  of  malaria  during  one  of 
which  the  mercury  reached  106  P.  The  chills  and  fever  yielded 
to  large  doses  of  quinin. 

Case  16. — Henry  H.  Mix,  age  21,  Third  Infantry,  Company 
F,  enlisted  three  months  ago.  On  June  6  last,  while  on  parade 
had  an  attack  of  heat  exhaustion  followed  by  diarrhea  for  sev- 
eral days.  At  Tampa,  June  8,  two  days  later,  he  was  put  on 
sick  list  for  two  furuncles  behind  the  left  knee.  These  healed 
promply.  July  10  on  reaching  Cuba,  he  suffered  from  furun- 
cles on  buttocks,  also  malarial  fever  and  diarrhea.  At  this 
time  an  abscess  formed  in  the  right  popliteal  space,  which  pur- 
sued an  insidious,  chronic  course.  At  the  time  the  patient 
reached  Montauk,  he  was  very  anemic  and  almost  reduced  to  a 
skeleton,  and  the  abscess  had  opened  at  different  points.  The 
subcutaneous  tissue  was  extensively  undermined,  and  through 
the  openings  the  fungous  lining  of  the  cavity  could  be  distinctly- 
seen.  Ths  abscess  cavity  discharged  profusely  and  extended 
from  the  middle  of  the  thigh  to  the  upper  portion  of  the  calf 
of  the  leg.  August  29,  the  sinuses  were  enlarged,  a  number  of 
counter-openings  made  and  free  tubular  drainage  established. 
The  abscess  cavity  was  thoroughly  disinfected  and  a  large  moist 
antiseptic  compress  applied.  As  there  was  some  tendency  to 
contraction  of  the  knee  joint,  the  limb  was  placed  in  a  straight 
position  and  immobilized  by  the  use  of  a  well  padded  anterior 
wire  splint  so  applied  that  the  abscess  could  be  exposed  and 
treated  without  disturbing  the  limb.  Malarial  fever,  which 
developed  on  the  second  day  after  the  operation,  retarded  the 
healing  process,  and  for  a  few  days  threatened  the  life  of  the 


200 


patient.  After  the  fever  was  under  control  by  the  administra- 
tion of  large  doses  of  quinin,  a  satisfactory  process  of  repair  set 
in,  which  soon  effected  healing  of  the  abscess  and  restoration 
of  tisssues  lost  by  the  extensive  destructive  process. 

Case  17. — Joseph  McGuire,  Ninth  Massachusetts  Volunteers, 
Company  C,  had  some  febrile  attack  in  Cuba,  the  nature  of 
which  is  not  known.  He  was  admitted  to  the  surgical  depart- 
ment of  the  General  Hospital,  September  7,  suffering  from  a 
superficial  connective  tissue  abscess  over  left  triceps  about  two 
inches  below  the  shoulder  joint.  He  has  at  the  same  time  an 
alveolar  abscess  which  is  discharging  through  a  carious  tooth. 
The  infection  in  this  case  evidently  took  place  from  the  blood,  as 
there  are  no  traces  of  the  existence  of  a  local  infection  atrium 
to  which  the  phlegmonous  process  could  be  attributed. 
Through  drainage  and  moist  carbolized  dressing. 

Case  i<S.— James  F.  Dite,  age  21,  First  Illinois  Infantry, 
Company  H,  received  a  severe  contusion  of  anterior  surface  of 
right  thigh  from  falling  log  near  Santiago.  He  was  treated  by 
a  Cuban  doctor  for  rheumatism,  and  then  sent  to  the  Division 
Hospital  where  a  swelling  which  had  formed  at  the  site  of  in- 
jury was  incised,  but  no  pus  escaped.  The  swelling  remained, 
and  gradually  increased  in  size.  When  admitted  to  the  surgi- 
cal ward  his  general  health  was  precarious.  Marked  anemia 
and  emaciation.  The  anterior  aspect  of  the  affected  thigh 
from  near  the  knee  to  the  inguinal  fold  was  the  seat  of  a  fluc- 
tuating swelling.  The  center  of  the  swelling  was  occupied  by 
a  small  granulating  area  marking  the  place  where  the  incision 
was  made.  The  abscess  was  underneath  the  quadriceps  femo- 
ris  muscle,  and  evidently  the  incision  had  not  been  made  deep 
enough  to  reach  the  pus.  As  the  skin  was  not  broken  by  the 
injury,  infection  was  determined  by  microbes  floating  in  the 
circulation  and  their  localization  and  growth  in  the  contused 
deep  connective  tissue.  Under  anesthesia  the  abscess  was 
opened  at  the  most  dependent  point  and  a  counter  opening 
made  on  the  opposite  side  with  the  aid  of  distension  of  the  cav- 
ity by  peroxid  of  hydrogen  injection.  Through  drainage  and 
thorough  disinfection  of  the  interior  of  the  abscess  cavity 
completed  the  operation.  Prompt  relief  and  improvement  fol- 
lowed the  operative  intervention. 

Case  19. — Dennis  Riley,  age  21,  First  District  of  Columbia 
Infantry,  Company  E,  after  passing  through  a  rather  severe 
attack  of  typhoid  fever  was  admitted  to  the  surgical  ward 
suffering  from  multiple  abscesses,  varying  in  size  from  that  of 
a  pea  to  a  walnut,  involving  the  face  and  the  neck.  The  largest 
abscess  was  above  the  left  eyelid.  All  of  these  abscesses  had 
their  primary  starting  point  in  the  subcutaneous  connective 
tissue.  Treatment  by  incision  and  drainage.  Convalescence 
progressed  without  any  further  interruption.  The  location  of 
these  abscesses  on  the  exposed  part  of  the  body  would  indicate 
that  the  infection  had  a  local  source,  probably  slight  abrasions 


201 

inflicted  by   the  patient  himself    during   the  course  of    the 
fever. 

Case  m— Edwin  Stockwell,  aged  28,  Second  Infantry,  Com- 
pany I,  was  well  until  the  day  before  leaving  Cuba,  August  10  ; 
on  that  day  felt  very  weak  and  sick.  On  boarding  transport  had 
to  lie  down,  vomited,  then  felt  better  for  a  time,  then  weak 
and  sick  and  nausea  and  vomiting  again.  He  was  feverish  all 
the  time  and  slightly  jaundiced,  but  continued  on  duty  with 
the  sick.  Some  doubt  remains  as  to  whether  this  attack  was  a 
mild  form  of  yellow  fever  or  malaria.  Since  his  arrival  here 
he  has  done  duty  as  a  nurse.  Five  or  six  days  ago  a  furuncle 
developed  on  the  middle  of  the  posterior  aspect  of  the  right 
thigh,  below  the  gluteal  fold.  This  opened  and  discharged 
slightly,  but  the  swelling  has  continued  to  increase  in  size. 
On  examination,  a  crater-like  defect  in  the  skin  marks  the  site 
of  the  primary  focus  of  infection.  From  this  point  a  red  zone 
of  inflammation  extends  in  all  directions  equally  to  a  distance 
of  two  inches.  The  phlegmonous  progressive  connective  tissue 
inflammation  had  its  origin  from  the  furuncle.  Such  a  compli- 
cation would  probably  not  have  occurred  if  the  patient's  gen- 
eral health  and  power  of  resistance  tD  general  infection  had 
not  been  impaired  by  the  antecedent  attack  of  fever.  The 
skin  around  the  furuncle  was  extensively  undermined.  The 
cavity  was  freely  laid  open  by  a  vertical  incision  and  the 
necrosed  tissue  and  infectived  granulations  scraped  out  with  a 
sharp  spoon,  and  after  thorough  disinfection  was  lightly  packed 
with  a  strip  of  iodoform  gauze,  and  a  large  moist  compress 
applied. 

Case  2i.— John  A.  Johnson,  aged  24,  Third  Infantry,  Com- 
pany H,  enlisted  eight  months  ago.  Phlegmonous  inflamma- 
tion of  middle  finger  of  left  hand.  Three  weeks  ago  had  an 
attack  of  malarial  fever  in  Cuba,  which  was  complicated  by 
diarrhea.  He  was  treated  four  days  in  one  of  the  hospitals, 
when  he  returned  to  his  command  for  duty.  The  fever  left 
him  in  a  weakened  condition.  Ten  days  ago  on  leaving  San- 
tiago, he  noticed  a  soreness  over  the  dorsal  side  of  the  middle 
finger  of  the  left  hand  directly  over  the  middle  joint.  Cause 
of  infection  not  known.  An  acute  superficial  abscess  formed, 
attended  by  great  pain  until  it  ruptured,  A  considerable  por- 
tion of  the  overlying  skin  sloughed,  leaving  a  ragged  surface 
with  edematous  red  margins.  On  August  27,  the  patient  was 
placed  under  an  anesthetic,  when  a  thorough  examination 
showed  that  the  infective  process  did  not  extend  to  the  joint 
or  the  extensor  tendon.  With  sharp  spoon,  scissors  and  for- 
ceps the  infected  tissues  were  removed,  the  resulting  surface 
disinfected  and  packed  with  iodoform  gauze  and  the  finger 
immobilized  on  a  palmar  splint.  The  wound  healed  promptly 
and  the  prospects  are  that  the  finger  will  regain  its  normal 
functions. 

Case  2^.— Richter,  aged  23,  First  Illinois  Infantry,  Company 


202 


D,  contracted  typhoid  fever  in  Cuba  five  weeks  ago.  During 
the  fever  a  copious  herpetic  eruption  made  its  appearance  on 
the  upper  lip  and  about  the  nasal  orifices.  The  fever  left  him 
in  a  greatly  emaciated  condition.  A  swelling  formed  in  the 
left  cheek  during  the  last  three  or  four  days  and  increased 
rapidly  in  size.  Pain  and  tenderness  not  well  marked.  The 
patient  sought  medical  treatment  at  the  surgical  ward  Sun- 
day, September  11.  The  left  cheek  was  the  seat  of  a  large 
fluctuating  swelling.  Diagnosis  made  at  the  time — abscess  of 
cheek.  The  abscess  was  incised  from  the  mouth  and  a  large 
quantity  of  very  offensive  pus  was  evacuated.  The  patient  was 
directed  to  resort  to  frequent  rinsings  of  the  mouth  with  a 
saturated  solution  of  boracic  acid  and  was  given  a  furlough  to 
enable  him  to  return  as  quickly  as  possible  to  his  home.  Infec- 
tion in  this  case  undoubtedly  occurred  through  the  skin  defects 
left  by  the  herpetic  eruption. 

GLANDULAR    ABSCESS. 

In  the  discussion  of  phlegmonous  abscess,  infection  was 
traced  either  to  a  portio  invasionis  or  local  conditions,  which 
determined  localization  from  local  causes,  in  cases  in  which  it 
was  reasonable  to  suppose  that  the  essential  cause  of  infection 
existed  in  the  general  circulation.  Without  calling  attention  to 
the  fact,  it  is  reasonable  to  suppose  that  in  the  first  class  of 
patients  the  essential  microbic  cause  reached  the  tissues 
through  the  connective  tissue  spaces,  that  is,  that  a  direct 
anatomic  connection  existed  between  the  primary  essential 
infection-atrium  and  the  seat  of  secondary  phlegmonous  man- 
ifestations. In  the  consideration  of  glandular  infection  it  is 
essential  to  connect  the  infection-atrium  anatomically  and 
physiologically,  with  the  secondary  glandular  suppurative  con- 
ditions. We  are  able  from  the  clinical  history  and  the  patho- 
logic conditicns  presented  in  most  of  the  cases  to  establish  such 
a  direct  connection  between  the  primary  source  of  infection 
and  the  secondary  glandular  manifestations.  I  have  reason  to 
believe  that  in  most  of  these  cases  the  essential  cause  of  infec- 
tion was  the  streptococcus  pyogenes,  because  it  is  well  known 
that  this  pyogenic  agent  usually  follows  either  the  connective 
tissue  spaces  or  the  lymphatic  channels  in  giving  rise  to  a  dis- 
tant infective  suppurative  process. 

Case  ^5.— Patrick  Collins,  age  28,  Company  C,  Eighth  In- 
fantry, enlisted  one  year  ago.  About  the  middle  of  July,  while 
in  Cuba,  had  a  malarial  chill  followed  by  fever.  Has  had  fever 
and  diarrhea,  and  has  been  on  the  sick  list  ever  since.  While 
returning  on   transport  from  Cuba  he  experienced  soreness  in 


203 

the  region  of  the  left  parotid  ^iand  ;  this  symptom  has  been 
followed  by  the  usual  clinical  evidences  indicative  of  the  exist- 
ence of  an  abscess  in  that  locality.  On  August  29  he  presented 
himself  at  the  surgical  ward,  and  at  that  time  it  was  not  diffi- 
cult to  diagnosticate  the  existence  of  a  large  abscess  in  the 
region  of  the  parotid  gland.  At  that  time,  under  ether  anes- 
thesia, it  was  easy  to  recognize  a  diffuse  abscess  in  the  parotid 
region.  It  was  more  difficult  to  decide  whether  this  abscess 
was  of  malarial  or  typhoid  origin.  Two  incisions  were  made, 
an  extensive  purulent  product  was  evacuated,  and  efficient 
through  tubular  drainage  was  established.  In  this  instance  the 
whole  gland  seemed  to  be  surrounded  by  the  suppurative  prod- 
ucts and  the  through  drain  was  passed  underneath  the  glaod 
that  was  the  primary  seat  of  the  secondary  field  of  infection 
The  patient  improved  rapidly  after  the  operation. 

Case  24.— John  Williams,  age  25,  Ninth  Cavalry,  Troop 
F.,  colored,  enlisted  four  months  ago.  Following  a  strain  in 
hfting  and  exposure  in  rough  weather,  while  on  duty  in  the 
Camp  at  Tampa,  Fia.,  he  became  aware  of  the  enlargement  of 
the  inguinal  glands  on  the  right  side.  The  glands  were  very 
painful  when  he  was  on  active  duty.  There  are  no  evidences 
of  general  infection  of  any  kind  and  the  most  scrutinizing  ex- 
amination failed  to  detect  any  tangible  source  of  infection  in 
the  distal  side  of  the  lymphatic  circulation.  On  palpating 
three  or  four  inguical  glands  were  found  distinctly  enlarged 
with  plain  evidences  of  beginning  perilymphadenitis,  but  no 
distinct  abscess  formation.  On  August  22  chloroform  was  ad- 
ministered and  a  curved  incision  made,  with  the  convexity  di- 
rected upward  in  such  a  manner  as  to  expose  the  infected 
glands  freely.  The  glands,  three  in  number,  honeycombed 
with  pus  were  enucleated.  A  place  for  drainage  was  estab- 
lished, the  wound  thoroughly  disinfected  with  iodoform,  when 
the  external  incision  was  closed  with  sutures  of  horsehair. 
The  wound  healed  promptly  by  primary  intention. 

Case  1^5.— George  A.  Roberts,  Sixteenth  Infantry,  Company 
H.,  colored,  was  ill  eight  days  with  malaria  in  Cuba,  was  af- 
ter that  on  duty  until  his  arrival  in  Montauk,  when  he  again 
had  malarial  fever.  During  this  attack  a  furuncle  devel- 
oped on  calf  of  the  right  leg  and  opened  spontaneously.  From 
this  point  a  lymphadenitis  started,  which  extends  to  the  deep 
ymphatic  glands  in  Scarpa's  triangle  and  terminated  in  a 
lymphadenitis  and  perilymphadenitis.  The  lymphatic  glands 
in  this  region,  being  in  a  state  of  inflammation, 
resulted  in  the  formation  of  a  tender  and  painful 
swelling  four  inches  in  length  and  about  three  inches 
in  width.  No  fluctuation  and  no  inflammatory  discoloration 
of  the  skin.  The  patient  was  confined  to  his  cot  with  the  af- 
fected limb  in  an  elevated  position.  A  large  compress  satur- 
ated with  2,^  per  cent,  hot  solutionof  carbolic  acid.  Applied 
Cred(^'s  silver  ointment  to  be  rubbed  into  the  skin  over  the  swell- 


204 


ing  once  a  day.  Under  this  treatment  the  inflammatory  process 
subsided  and  the  prospects  are,  that  the  swelling  will  disap- 
pear without  pus  formation. 

Case  ^6'.— Frederick  Warner,  age  37,  colored,  Ninth  Cav- 
alry, Troop  L,  contracted  chancroid  about  six  weeks  ago,  while 
on  duty  at  Tampa.  The  lymphatic  glands  in  the  inguinal 
region  became  infected  and  the  suppurative  lymphadenitis 
terminated  in  the  formation  of  three  glandular  abscesses, 
which  opened  spontaneously.  At  the  time  the  patient  was 
operated  upon,  September  1,  three  fistulous  openings  were 
found,  and  the  connective  tissue  was  extensively  infiltrated. 
Xo  scars  or  other  evidences  of  the  primary  lesion  can  be  de- 
tected. It  was  plainly  a  case  of  suppurative  lymphadenitis, 
caused  by  invasion  with  pus  microbes  from  the  external  geni- 
tals. Under  chloroform  anesthesia  the  sinuses  were  enlarged, 
and  the  remaining  broken  down  gland  tissue  and  infected  gran- 
ulations removed  by  a  vigorous  use  of  the  sharp  spoon.  The 
resulting  wound  was  thoroughly  disinfected,  iodoformized  and 
packed  with  iodoform  gauze  and  covered  with  a  large  moist 
antiseptic  compress  of  gauze,  over  which  was  placed  an  over- 
lapping piece  of  oiled  silk,  and  the  whole  dressing  held  in 
place  by  a  bandage  embracing  the  pelvis  and  upper  part  of 
thigh.  The  patient  left  the  hospital  a  week  after  the  opera- 
tion, at  which  time  the  abscess  cavities  were  much  diminished 
in  size  and  lined  by  vigorous  healthy  granulations. 

Case  27. — John  H.  Butler,  age  21,  Ninth  Cavalry,  Troop  L, 
colored.  Tubercular  lymphadenitis  of  submaxillary  gland. 
Family  history  negative.  Mother  and  father  living  ;  two  chil- 
dren died  in  infancy  :  rest  living  and  in  good  health.  About 
two  months  ago  began  to  have  pain  in  right  side  of  neck  and 
submaxillary  region,  and  then  noticed  a  small,  hard  swelling 
below  the  angle  of  the  jaw.  Additional  glands  in  the  same 
region  became  involved.  At  the  time  he  entered  the  surgical 
ward  a  large  glandular  mass,  composed  of  several  enlarged 
lymphatic  glands,  was  found  in  the  right  submaxillary  region. 
On  palpation  the  swelling  was  painful,  but  no  distinct  fluctua- 
tion could  be  felt.  Inspection  of  the  mouth  failed  to  reveal 
anything  which  could  be  regarded  as  an  infection-atrium.  The 
tubercular  nature  of  the  glandular  affection  was  recognized, 
and  a  radical  operation  for  the  removal  of  the  glands  was  per- 
formed September  6,  the  patient  being  under  the  influence  of 
chloroform.  The  glandular  mass  was  freely  exposed  by  a 
semilunar  incision  with  the  convexity  downward  and  by  reflec- 
tion of  the  cutaneous  flap  in  an  upward  direction.  The  whole 
mass  was  dissected  out  in  one  piece,  which  included  not  only 
the  tubercular  glands,  but  likewise  the  infiltrated  connective 
tissue  surrounding  them.  The  submaxillary  gland  was  ex- 
posed, and  during  the  latter  part  of  the  operation  it  became 
necessary  to  cut  and  ligate  the  facial  artery.  The  gland  tissue 
throughout  had  undergone  coagulation  necrosis ;  each  gland 


205 

contained  several  foci  of  caseation.  The  wound  was  iodo- 
formized  and  sutured  throughout  with  horse-hair,  provision 
for  gauze  drainage  having  been  made  by  making  a  button  hole 
near  the  margin  and  center  of  the  flap.  Healing  by  primary 
intention. 

Case  V8.— Schuyler  C.  Black,  age  31,  Ninth  Cavalry,  Troop 
I,  colored,  enlisted  four  months  ago.  Chronic  balanitis  and 
bilateral  plastic  lymphadenitis  of  inguinal  glands.  In  June  last 
noticed  enlargement  of  inguinal  glands  on  both  sides,  follow- 
ing a  small  sore  on  the  glans  penis  near  the  corona.  He  was 
treated  for  primary  syphilis,  and  was  given  large  doses  of 
potassic  iodid.  At  no  time  was  there  any  induration  at  the 
base  of  the  sore,  which  always  presented  the  appearance  of  an 
abrasion  rather  than  an  ulcer.  At  no  time  have  there  been  any 
indications  of  secondary  syphilis.  The  lymphatic  glands  in 
other  regions  of  the  body  are  normal.  The  patient  states  that 
the  sore  has  healed  repeatedly,  reappearing  at  varying  inter- 
vals in  the  same  place.  Examination  of  the  penis  reveals 
slight  phimosis,  chronic  balanitis  which  has  resulted  in  great 
thickening  of  the  mucosa  lining  the  prepuce.  The  sore,  which 
has  been  a  source  of  great  mental  distress  to  the  patient,  ap- 
pears in  the  form  of  a  very  superficial  abrasion  not  larger  than 
a  split  pea  with  ill  defined  margins  and  no  induration  whatever 
at  its  base.  Recently  the  preputial  margin  became  the  seat 
of  a  herpetic  eruption.  The  lymphatic  glands  in  both  groins 
are  hard,  not  very  tender  to  the  touch  and  vary  in  size  from 
that  of  a  pea  to  a  hazelnut.  September  13,  typical  circumci- 
sion was  performed  under  chloroform  narcosis.  It  is  expected 
that  the  removal  of  the  direct  cause  of  the  lymphadenitis  will 
be  followed  by  a  speedy  reduction  in  the  size  of  the  glands. 
The  essential  cause  is  to  be  attributed  to  the  entrance  of  pus 
microbes  into  the  lymph  channels  from  the  local  lesions  of  the 
glans  penis  and  prepuce  which  became  arrested  in  the  lym- 
phatic filters,  producing  an  inflammation  which  came  to  a 
standstill  short  of  suppuration. 

Case  i-P.— Robert  V.  Smith,  age  21,  Tenth  Cavalry,  Troop 
E,  colored,  enlisted  June  20.  A  month  ago  while  in  camp  in 
Florida,  he  noticed  a  number  of  small  pimples  on  the  scalp  on 
the  right  side.  These  small  furuncles  still  exist,  and  a  week 
ago  gave  rise  to  a  deep  seated  lymphadenitis  affecting  the 
lymphatic  glands  in  the  superior  posterior  triangle  on  the  cor- 
responding side  of  the  neck.  When  the  patient  came  under 
observation,  September  13,  a  large  and  somewhat  diffuse  swell- 
ing marked  the  location  of  the  infected  glands  ;  evidently  the 
connective  tissue  around  and  between  the  glands  is  secondarily 
implicated  in  the  inflammatory  process.  The  swelling  is  hard 
and  tender  on  pressure.  No  signs  of  central  softening. 
Evening  temperature  102  F.,  morning  temperature  100  F.  Di- 
rections were  given  to  clip  the  hair  short,  and  to  disinfect  the 
entire  scalp.     Crede's  silver  ointment  to  be   rubbed  into  the 


206 

skin  over  the  swelling  and  to  apply  a  hot,  moist  antiseptic  com- 
press. The  patient  is  anemic,  for  which  condition  Gude's 
pepto  mangan  was  prescribed.  There  is  some  prospect  that 
the  removal  of  the  source  of  infection  and  the  local  applications 
will  succeed  in  arresting  the  process  and  in  effecting  resorption 
of  the  inflammatory  product. 

This  hope  was  not  realized,  as  a  few  days  later,  September  23, 
distinct  fluctuation  was  felt  and  the  abscess  was  incised  and 
drained,  the  patient  being  under  the  influence  of  chloroform. 
Rapid  improvement  followed  the  operation. 

ABSCESS  FOLLOWING  TYPHOID   FEVER. 

It  is  somewhat  singular  that  among  the  hundreds  of  cases  of 
typhoid  fever,  that  I  had  an  opportunity  to  see  and  examine  in 
Porto  Rico  and  in  this  great  national  camp,  no  cases  of  perfor- 
ation have  come  to  my  notice.  I  kept  myself  in  readiness  to 
perform  laparotomy  at  a  moment's  notice,  but  my  services  were 
never  requested  for  this  particular  purpose.  I  have  no  doubt 
but  that  some  of  the  deaths  from  typhoid  fever  were  due  to  this 
cause,  and  that  this  fatal  complication  was  either  overlooked  or 
the  general  condition  of  the  patient  was  so  grave  when  it  oc- 
curred, that  the  attending  physicians  did  not  deem  it  advisable 
to  send  for  the  surgeon.  In  this  camp  we  had  all  the  necessary 
facilities  for  abdominal  operations,  and  I  was  hopeful  that  I 
should  have  an  opportunity  to  give  surgery  a  fair  trial  in  such 
cases,  but  in  this  I  have  been  disappointed.  The  most  import- 
ant, and  most  frequent  complications  of  our  typhoid  fever  pa- 
tients have  been  bedsores  and  abscesses.  The  careful  and  at- 
tentive nursing  our  patients  here  have  received,  has  done 
much  in  reducing  the  mortality  and  suffering  from  decubitus. 
Frequent  washing  with  alcohol  of  the  parts  exposed  to  decu- 
bitus and  the  use  of  rubber  pillows,  and  in  the  worst  cases,  of 
water  or  air  beds,  have  contributed  much  in  the  prevention 
and  successful  treatment  of  this  complication.  We  have  had 
however,  an  excellent  opportunity  to  study  the  etiology  and 
pathology  of  abscesses  as  a  complication  of  typhoid  fever.  The 
material  was  abundant  and  interesting.  It  is  a  source  of 
regret  to  me  that  we  did  not  have  at  our  disposal  a  well-equip- 
ped bacteriologic  laboratory  to  enable  us  to  study  in  a  more  sat- 
isfactory manner  the  contents  of  those  abscesses.  Acting  As- 
sistant-Surgeon Ewing  brought  his  own  microscopic  outfit,  in- 
cluding the  different  stains,  and  did  good  work  in  the  micro- 
scopic examination  of  pus  and  other  pathologic  products,  but 


207 


we  had  no  facilities  for  making  cultures.  He  examined  the 
contents  of  three  abscesses  in  as  many  patients,  and  found  as 
the  essential  bacteriologic  cause  the  bacillus  of  typhoid  in  one 
and  the  ordinary  pus  microbes  in  the  remaining  two  cases. 

The  typhoid  or  so-called  metastatic  abscesses  are  caused 
by  the  bacillus  of  typhoid  fever  or  by  pus  microbes  which  find 
their  way  into  the  circulation  through  some  infection-atrium, 
especially  the  intestinal  ulcers,  as  the  result  of  a  mixed  infec- 
tion. [  have  no  doubt  that  in  some  cases  the  colon  bacillus 
finds  its  way  into  the  general  circulation  and  produces  the 
same  results.  The  only  case  of  bone  and  joint  infection  that 
came  under  my  observation,  and  that  could  be  brought  in  con- 
nection with  the  typhoid  infection  occurred  in  the  case  of  a 
young  soldier  recovering  from  a  severe  attack  of  typhoid  fever. 

Case  30. — William  Pairweather,  age  22,  Company  A,  Twelfth 
Infantry,  about  one  week  after  the  surrender  of  Santiago, 
was  attacked  with  fever  which  continued  for  three  weeks.  He 
reached  this  camp  with  his  regiment,  emaciated  to  a  skeleton, 
and  extremely  anemic.  A  week  ago,  while  moving  about,  he 
was  attacked  rather  suddenly  with  a  severe  pain  in  the  right 
sacroiliac  synchondrosis  and  extending  to  the  leg  on  the  same 
side.  The  pain  in  the  leg  subsided  after  a  few  days  but  in- 
creased in  severity  at  the  point  where  it  first  commenced.  The 
pain  is  of  a  dull,  aching,  throbbing  character.  Slight  swelling 
over  and  in  the  line  of  the  joint.  Evening  temperature  one  de- 
gree above  normal.  No  redness  or  edema  of  the  skin.  Septem- 
ber 6,  the  joint  was  punctured  with  the  largest  needle  of  an 
exploring  syringe  and  a  5  per  cent,  solution  of  carbolic  acid 
was  injected  in  different  directions,  so  as  to  reach  the  infected 
tissues  as  far  as  possible.  No  difficulty  was  met  with  in  inject- 
ing three  drachms  of  the  solution.  The  needle  puncture 
was  sealed  with  collodium  and  a  pledget  of  cotton.  Marked 
improvement  followed  the  intra  articular  and  parenchymatous 
injection.  The  pain  and  tenderness  had  nearly  disappeared  on 
the  third  day.  Under  tonics  and  stimulants  the  general  con- 
dition of  the  patient  improved  from  day  to  day.  There  is  no 
reason  to  fear  at  this  time  that  suppuration  will  take  place. 

This  case  represents  oae  of  those  rare  complications  of 
typhoid  fever  in  which  a  joint  becomes  the  seat  of  secondary 
infection  during  the  latter  stages  of  typhoid  fever  or  during 
convalescence,  in  which  the  inflammatory  process  often  results 
in  great  destruction  of  tissue  without  pus  formation.  Whether 
or  not  the  injection  should  be  credited  with  having  brought 
about  the  speedy  cessation  of  active  symptoms  can  not  be  de- 


208 


cided,  either  way  with  any  degree  of  positiveness.  I  have 
learned  to  value  the  therapeutic  effect  of  parenchymatous  in- 
jections of  carbolic  acid  in  the  treatment  of  chronic  or  suba- 
cute inflammation  of  a  non  tubercular  inflammation,  and  I  am 
inclined  to  attribute  to  it  in  this  particular  and  similar  cases 
positive  curative  properties,  the  evidence  of  which  in  this  case 
appeared  so  shortly  after  it  was  made. 

Case  31. — C.  H.  Baker,  aged  22,  Company  P,  Second  Massa- 
chusetts Infantry,  was  sick  two  months  in  Cuba  with  fever, 
malaria,  headache,  a^norexia,  diarrhea,  in  consequence  of  which 
he  became  very  weak.  Shortly  after  boarding  the  transport, 
he  became  delirious  and  has  been  sick  with  typhoid  fever  for 
three  weeks.  A  week  ago,  while  convalescent,  he  was  attacked 
suddenly  with  violent  pain  in  the  right  testicle  which  rapidly 
increased  in  size,  reaching  the  dimensions  of  a  small  orange  in 
the  course  of  two  days.  At  that  time,  the  temperature  in- 
creased two  degrees  above  normal.  On  the  third  day  after  the 
attack,  the  swelling  was  hard,  very  sensitive  to  the  touch,  the 
skin  red  and  glossy.  No  chills.  Under  applications  of  lead 
water  and  opium  the  pain  has  been  somewhat  mitigated  and 
the  swelling  slightly  diminished  in  size.  September  10,  a  week 
after  the  complication  had  set  in,  the  patient  was  transferred 
to  the  surgical  ward.  At  this  time  deep-seated  fluctuation  could 
be  distinctly  felt  over  the  center  of  the  swelling.  Lees  discol- 
oration of  the  skin  than  a  few  days  ago.  Swelling  only  about 
twice  the  size  of  the  normal  testicle.  The  abscess  appears  to 
occupy  the  center  of  the  testicle.  Under  ether  anesthesia  the 
abscess  cavity  was  opened  at  the  most  dependent  point,  and  a 
counter-opening  two  inches  higher  up  made  by  tunnelling  the 
tissues  from  within  outward  with  a  curved  hemostatic  forceps, 
and  through  drainage  established.  The  pus  was  of  the  con- 
sistence of  cream  and  whitish  in  color.  No  transudation  into 
the  tunica  vaginalis.  The  conditions  revealed  at  the  time  of 
operation  left  no  doubt  regarding  the  parenchymatous  central 
origin  of  the  abscess.  Microscopic  examination  of  the  pus 
removed  showed  typhoid  bacilli  in  great  abundance  as  the  ex- 
clusive bacteriologic  cause  of  the  suppurative  orchitis.  The 
patient  improved  very  rapidly  after  the  operation,  and  was 
transferred  in  less  than  a  week  to  one  of  the  Boston  city 
hospitals. 

Case  32. — L.  Gardner,  age  38,  Company  A,  Sixth  Infantry, 
went  through  the  Cuban  campaign  with  two  days'  slight  ill- 
ness. He  lost  flesh,  but  felt  well  until  he  came  on  the  trans- 
port four  weeks  ago,  when  he  was  attacked  with  fever  which 
proved  to  be  typhoid  complicated  by  malaria  as  shown  by  the 
erratic  temperature  curves.  Convalescence  was  preceded  by 
inflammation  of  the  left  parotid  gland.  Emaciation  marked. 
Spleen  much  enlarged.     The  liver  dulness  extends  from  the 


209 

sixth  rib  to  an  inch  below  the  costal  arch.  Lungs  normal. 
Heart  sounds  clear  and  distinct.  Pulse  strong  and  regular. 
Tongue  red  and  glazed.  A  week  after  the  beginning  of  the  at- 
tack, a  large  abscess  had  formed  and  fluctuation  could  be  dis- 
tinctly felt,  extending  from  a  level  with  the  external  meatus  to 
near  the  angle  of  the  jaw.  At  that  time,  September  7, 
the  patient  was  etherized,  the  abscess  opened  at  the  lowest 
and  highest  points,  and  through  drainage  estiblished,  a 
large  quantity  of  thick  purulent,  curdy  pus  escaped.  The 
cavity  was  washed  out  with  a  2.5  per  cent,  carbolic  solution 
and  peroxid  of  hydrogen,  and  a  large,  moist,  hot  antiseptic 
compress  applied.  Improvement  followed  at  once  and  ended 
in  a  slow  recovery  without  any  interruptions. 

Case  33. — Patrick  Collins,  age  26,  Eighth  Infantry,  Company 
C,  has  been  in  the  service  one  year.  About  two  weeks  after 
the  fight  in  Cuba  was  attacked  with  malaria,  which  was  fol- 
lowed by  typhoid.  The  fever  has  persisted  since,  attended  by 
diarrhea  and  other  symptoms  indicating  its  nature.  While  on 
the  transport  on  his  return  he  complained  of  a  sense  of  sore- 
ness in  the  left  parotid  region,  followed  by  swelling  and  red- 
ness. Patient  much  emaciated  and  very  feeble.  At  the  time 
the  operation  was  performed,  August  29,  the  swelling  extended 
from  the  external  ear  to  near  the  angle  of  the  jaw,  and  deep- 
seated  fluctuation  was  distinct.  Incision,  drainage,  disinfec- 
tion and  after-treatment  the  same  as  in  the  preceding  case. 
Owing  to  the  marked  weakness  of  the  heart's  action,  the  pa- 
tient was  given  two  ounces  of  whisky  before  he  was  placed 
under  the  influence  of  ether.  Alcoholic  stimulants  were  admin- 
istered in  large  and  frequently  repeated  doses  and  acted  very 
promptly  in  increasing  the  tone  of  the  circulation  and  in  build- 
ing up  the  impaired  nutrition.  The  discharge  from  the  abscess 
in  this,  as  well  as  the  other  cases  of  abscess  of  the  parotid  fol- 
lowing typhoid  fever,  was  very  slight  after  the  evacuation  of 
the  abscess  contents. 

Case  34. — Harold  Robinson,  age  28,  Third  Infantry,  Com- 
pany D,  contracted  typhoid  fever  in  Cuba.  He  is  now  in  the 
third  week  of  the  fever  and  has  been  delirious  most  of  the 
time.  The  disease  pursued  almost  from  the  beginning  a  very 
malignant  course.  About  five  days  ago  a  swelling  was  detected 
in  the  region  of  the  right  parotid  gland,  which  increased  very 
rapidly  in  size,  involving  the  skin  after  two  or  three  days.  The 
abscess  ruptured  on  the  fourth  day  into  the  external  meatus, 
but  evacuation  was  incomplete  on  account  of  the  existence  of 
several  separate  compartments  in  the  abscess  cavity,  which 
were  discovered  at  the  time  the  operation  was  performed.  The 
abdomen  is  intensely  tympanitic,  the  skin  of  feet,  legs  and 
abdomen  spotted  with  dark  points  of  ecchymosis.  The  con- 
dition of  the  patient  was  critical  when  the  operation  was 
performed,  September  10.  The  operation  had  to  be  performed 
without  an  anesthetic  and  in  his  ward,  as  he  was  too  feeble  to 


210 

justify  his  transfer  to  the  surgical  ward.  The  impoverished 
condition  of  the  blood  made  it  necessary  to  make  the  incision 
only  through  the  skin,  completing  the  opening  with  hemostatic 
forceps.  Free  tubular  drainage  was  established  and  the  abscess 
cavity  was  treated  in  the  usual  way.  Strychnia  and  alcoholic 
stimulants  were  administered  freely,  but  the  heart  failed  to 
respond  and  the  patient  died  the  next  day.  Notwithstanding 
that  the  openings  were  made  largely  by  the  use  of  blunt  instru- 
ments, free  oozing  of  blood  followed  the  operation,  which  may 
have  contributed  in  hastening  the  fatal  termination. 

Case  55.  — Giles  Potter,  age  33,  Second  Massachusetts  Infan- 
try, had  chills  and  fever  while  in  Cuba,  but  was  on  duty  con- 
tinuously. Was  still  weak  and  ill  when  he  came  on  board  the 
transport.  The  parotid  abscess  began  on  transport.  He  is 
very  weak  and  emaciated,  at  times  delirious ;  temperature  in- 
dicates typhoid  fever.  Conjunctivse  slightly  jaundiced.  Pulse 
small  and  thready.  Spleen  slightly  enlarged.  The  abscess 
was  incised  and  drained  without  the  use  of  an  anesthetic,  in 
its  stead  a  large  dose  of  whisky  was  given.  The  pus  in  this 
case  was  of  a  green  color.  Patient  improved  rapidly  after  the 
operation  and  is  now  on  the  way  to  convalescence. 

Case  56'.— John  Simpson,  age  28,  Troop  K,  First  Cavalry, 
was  admitted  to  the  general  hospital  August  25,  suffering  from 
typhoid  fever,  with  a  temperature  gradually  declining  until 
September  1,  when  it  rose  suddenly  from  99.4  to  102  and  103, 
dropping  on  the  8th  to  99.  On  admission  patient  had  very 
marked  roseolar  eruption  on  abdomen  and  limbs.  During  the 
course  of  the  fever  numerous  furuncles  appeared  on  the  fore- 
head and  back.  Delirium  has  been  a  prominent  feature  in  the 
case  almost  from  the  beginning.  Directly  following  the  sud- 
den rise  of  temperature  on  September  4,  soreness  and  swelling 
of  the  right  submaxillary  gland  were  noticed.  Today,  Sep- 
tember 10,  a  fluctuating  swelling,  the  size  of  a  small  apple, 
marks  the  location  and  size  of  the  abscess.  Operation  without 
anesthetic.  Incision,  counteropening,  tubular  drainage,  irri- 
gation with  peroxid  and  carbolic  solution,  wet  carbolic  dress- 
ing. Rapid  improvement  followed  the  operation  and  the 
patient  is  now,  September  13,  fairly  convalescent ;  abscess 
nearly  healed. 

The  parotid  gland,  of  all  glandular  organs,  is  the  most  fre- 
quent seat  of  secondary  infection  in  typhoid  fever.  For 
reasons  that  remain  unexplained  the  submaxillary  is  seldom 
involved,  and  the  sublingual  is  still  more  rarely  affected.  The 
infective  process  begins  in  the  parenchyma  of  the  salivary 
gland  but  extends  rapidly  to  the  capsule  and  the  surrounding 
connective  tissue,  leading  to  a  phlegmonous  process  which  in 
four  or  five  days,  as  a  rule,  terminates  in  a  well-marked  abscess 
with  the  gland  as  a  central  point.     The  physician  must  be  on 


211 


the  alert  in  such  cases,  and  resort  to  the  use  of  the  knife  in  a 
most  cautious  manner  as  soon  as  fluctuation  can  be  detected. 
It  is  advisable  to  establish  through  drainage  for  the  purpose 
of  securing  free  evacuation  and  thorough  disinfection  of  the 
interior  of  the  abscess  cavity.  The  openings  should  be  made 
by  cutting  only  the  skin  and  underlying  fascia  with  the  knife, 
completing  them  by  tunnelling  the  remaining  tissues  with  a 
curved  hemostatic  forceps.  Dry  dressings  should  not  be  em- 
ployed in  such  cases  ;  nothing  is  more  grateful  to  the  patient 
and  more  efficient  in  the  after-treatment  than  the  application 
of  a  moist,  hot,  antiseptic  compress  covered  with  oiled  silk  to 
retain  heat  and  moisture.  The  safest  and  most  efficient  solu- 
tion for  this  purpose  is  a  saturated  solution  of  acetate  of 
aluminium,  but  when  this  can  not  be  secured,  a  2.5  per  cent, 
solution  of  carbolic  acid  or  a  saturated  solution  of  boracic  acid 
answer  as  excellent  substitutes. 

In  the  next  case  the  clinical  history  is  very  defective,  and  it 
is  impossible  to  say  with  any  degree  of  certainty  whether  or 
not  the  parotid  abscesses  followed  in  the  course  of  typhoid 
fever,  or  whether  they  were  external  manifestations  of  a 
general  septic  process  that  developed  independently  of  that 
disease. 

Case  o7.— Austin  Dunlap,  age  19,  Company  H,  Third  Infan- 
try, was  taken  suddenly  ill  in  Tampa,  about  July  1,  with  pain 
in' the  back  and  joints  and  nausea.  The  disease  was  diagnos- 
ticated at  the  time  as  malaria.  He  was  sent  to  quarters,  and 
after  four  days  returned  to  duty.  On  arrival  at  this  camp, 
August  14,  had  three  severe  chills  during  the  first  twenty-four 
hours  and  has  been  very  sick  since.  When  admitted  to  the 
surgical  ward  with  bilateral  suppurative  parotitis  and  large 
bedsores,  he  was  reduced  to  a  skeleton.  Extensive  herpes 
labialis  which  near  the  left  angle  of  the  mouth  have  caused 
ulceration  ;  abscess  over  elbow  joint.  Pulse  rapid  and  very 
small,  temperature  irregular.  When  first  admitted  the  case 
was  regarded  as  a  forlorn  one  and  whiskey  was  given  in  ounce 
doses  hourly.  The  swelling  in  the  parotid  region,  on  both 
sides,  was  hard  and  very  sensitive  to  the  touch.  Crede's  sil- 
ver ointment  and  hot  antiseptic  compresses  constituted  the 
local  treatment.  Five  days  later  distinct  fluctuation  could  be 
detected  and  one  of  the  parotid  abscesses  was  incised  and  free 
tubular  drainage  effected.  Owing  to  his  critical  condition  the 
operations  had  to  be  performed  without  an  anesthetic.  The 
next  day,  September  10,  the  opposite  abscess  was  treated  in 
the  same  manner.     The  patient  has  been  placed  on  a  water- 


212 

bed  and  was  restless  and  most  of  the  time  delirious.  No  evi- 
dences of  metastasis  in  any  of  the  internal  organs.  Under  the 
stimulating  treatment  he  rallied  promptly  and  at  the  present 
time,  September  13,  his  mind  is  clear  and  the  temperature 
normal.  Discharge  from  abscess  cavities  slight.  The  drains 
are  shortened  from  time  to  time  to  permit  early  definitive  heal- 
ing of  the  abscesses. 

I  am  confident  that  early  operative  treatment  and  the  heroic 
employment  of  alcoholic  stimulants  have  been  the  principal 
means  in  saving  the  life  of  this  patient. 

Case  5.9.— Corporal  George  F.  Shilling,  age  18,  Company  G, 
First  D.  C.  Volunteers.  Enormous  typhoid  abscess  of  arm. 
Family  history  negative.  Health  excellent  before  he  went  to 
Cuba.  On  August  15  reported  sick  at  the  hospital.  Had 
been  feeling  ill  for  some  days.  He  has  been  delirious  most  of 
the  time  since  admission  to  the  General  Hospital  here.  The 
temperature  has  been  on  an  average  103  degrees  F.,  with 
daily  variation  of  a  degree  and  a  half  from  August  19  to  Sep- 
tember 4.  Since  latter  date  the  temperature  at  no  time  has 
been  over  101  degrees  F.  The  pulse  is  small,  rapid  and  weak, 
tongue  dry,  brown  and  fissured.  On  arriving  here  on  trans- 
port there  were  five  large  bedsores  on  back  and  numerous 
small  abscesses  of  the  skin.  He  was  placed  at  once  upon  a 
water-bed,  but  the  bedsores  continued  to  still  further  under- 
mine the  skin.  Two  days  ago  when  the  nurse  was  dressing 
the  bedsores,  she  discovered  a  swelling  of  the  right  arm  on  the 
outer  edge  of  the  biceps  muscle.  This  has  rapidly  increased 
in  size  and  now  presents  itself  as  an  enormous  abscess  extend- 
ing from  the  shoulder  to  the  tendon  of  the  biceps  muscle. 
Fluctuation  is  most  distinct  over  the  outer  aspect  of  the  arm. 
On  palpation  a  crackling  sensation  is  felt,  and  on  percussion 
the  swelling  was  distinctly  tympanitic.  The  presence  of  gas 
in  the  abscess  cavity  could  not  be  doubted.  September  12  the 
patient  was  almost  pulseless,  lips  cyanotic,  respiration  shal- 
low, and  marked  twitching  of  the  muscles  of  the  upper  extremi- 
ties. In  the  afternoon  the  abscess  was  cautiously  opened 
above  and  below  and  a  rubber  drainage  tube  drawn  through. 
A  large  quantity  of  an  offensive  gas  and  creamy  pus  was  evac- 
uated. The  abscess  cavity  was  freely  irrigated  withperoxid  of 
hydrogen  and  2.5  per  cent,  of  carbolic  solution  and  the  moist, 
hot  antiseptic  compress  applied.  In  place  of  an  anesthetic 
the  patient  was  given  an  ounce  of  whiskey,  which  was  to  be 
repeated  hourly.  Hot  water  bags  were  applied  to  relieve  the 
embarrassed  peripheral  circulation.  Contrary  to  our  expecta- 
tions, the  patient  rallied  under  this  treatment  and  presented  a 
much  more  encouraging  condition  the  next  morning,  when  it 
was  reported  that  the  temperature  was  nearly  normal,  mind 
clear  and  the  pulse  full  and  strong.  Microscopic  examination 
of  the  pus  by  Dr.  Ewing  revealed  :  1,  many  cocci  resembling 


213 

staphyloccus  pyogenes  ;  2,  a  few  large  capsulated  cocci ;  3,  a 
few  fine  slender  bacilli  staining  faintly  with  methylene  blue. 
There  is  nothing  that  resembles  the  bacillus  Eerogenes  capsula- 
tus.  The  patient  is  in  a  fair  way  to  recovery  (September  17). 
Case  40. — Fred  Angier,  age  23,  First  Cavalry,  Troop  I,  is  un- 
der treatment  for  typhoid  fever  probably  during  the  third 
week  of  his  illness.  Patient  is  delirious  and  it  is  impossible  to 
obtain  reliable  information  as  to  duration  of  his  sickness. 
Very  recently  the  right  eye  became  affected  by  an  acute  in- 
flammatory process  which  appears  to  involve  all  of  the  tissues 
of  the  organ.  The  eyelids  are  swollen,  red  and  somewhat  ede- 
matous. The  edema  extends  over  the  whole  malar  region. 
Exophthalmus  well  marked.  Pupil  contracted  and  immovable. 
Conjunctiva  in  a  state  of  catarrhal  inflammation.  Hypopion. 
Sent  to  the  New  York  Hospital,  August  30,  for  treatment  by 
specialist  of  the  eye  complication.  This  is  the  only  case  of 
secondary  infection  of  eye  of  a  typhoid  character  that  was  ob- 
served in  the  camp.  It  was  a  well-marked  case  of  panophtal- 
mitis  and  if  the  patient  recovers  it  will  be  with  the  loss  of  the 
affected  organ. 

ERYSIPELOID. 

Erysipeloid,  an  acute  inflammatory  affection  of  the  skin, 
described  by  J.  Rosenbach,  is  a  disease  of  the  skin  not  often 
recognized.  It  is  usually  mistaken  for  erysipelas.  The  para- 
site was  described  by  Rosenbach  more  than  ten  years  ago,  but 
it  has  never  been  classified.  Attempts  to  cultivate  it  have 
failed  so  far.  This  disease  is  met  with  usually  among  persons 
engaged  in  the  handling  of  fish  and  meat,  that  is,  cooks 
and  butchers.  It  is  attended  by  very  slight  constitutional 
disturbances  and  its  local  progression  is  slow  as  compared 
with  erysipelas.  The  starting  point  is  generally  a  finger, 
where  infection  takes  place  through  slight  surface  defects  or  a 
puncture.  It  consists,  pathologically  speaking,  of  a  subacute 
inflammation  of  the  lymphatic  channels  of  the  skin.  The 
affected  skin  presents  a  bluish  color  instead  of  the  bright  red 
seen  in  erysipelas.  Another  and  perhaps  more  important 
characteristic  sign  in  the  differentiation  between  erysipeloid 
and  erysipelas  is  the  appearance  of  the  margin  of  the  inflamed 
area.  In  erysipeloid  the  shading  from  diseased  into  healthy 
skin  is  gradual,  the  line  straight,  in  erysipelas  abrupt  and  the 
margin  presents  well-marked  fan-shaped  projections  instead  of 
a  straight  line.  The  thickening  of  the  skin  by  infiltration  in 
erpsipeloid  is  slight  and  the  only  thing  the  patient  complains 
of  is  a  sensation  of  burning  or  smarting.     The  disease  travels 


2L4 

in  the  direction  and  against  the  lymph-current,  so  that  when 
the  point  of  infection  is  some  distance  from  the  tip  of  the 
finger,  this  is  reached  in  time  by  extension  of  the  inflammation 
downward  from  the  point  of  infection.  The  disease  travels 
slowly,  it  usually  takes  a  week  or  more  before  the  inflamma- 
tion reaches  the  base  of  the  finger  when  infection  takes  place 
anywhere  near  its  tip.  The  lymphangitis  seldom  if  ever 
extends  beyond  the  elbow  joint.  The  infection  may  extend 
from  one  finger  to  another  when  the  inflammation  travels  in  a 
distal  direction.  The  skin  soon  returns  to  its  normal  condi- 
tion behind  the  zone  of  infection.  A  case  of  this  kind  came  to 
the  surgical  ward  for  treatment. 

Case  41. — Patrick  J.  M.  McGeoch,  age  24,  kitchen  employe, 
presented  himself  September  9,  complaining  of  a  burning, 
smarting  pain  in  the  right  index  finger,  which  commenced 
four  days  ago.  Over  the  radial  side  of  the  affected  finger, 
opposite  the  middle  joint,  is  a  small  abrasion  covered  by  a  thin 
adherent  crust.  The  skin  half  as  far  as  the  tip  of  the  finger 
and  an  inch  above  this  point  is  slightly  swollen  and  presents  a 
bluish  red  color.  The  discoloration  is  most  marked  on  the 
dorsal  side.  At  the  proximal  margin  of  the  zone  of  inflamma- 
tion the  diseased  gradually  shades  into  the  healthy  skin,  both 
in  regard  to  color  and  swelling.  Patient  is  able  to  follow  his 
occupation.  The  case  presents  all  the  characteristic  signs  of 
Rosenbach's  erysipeloid.  An  alcohol  compress  with  oiled  silk 
over  it  was  applied.  In  three  days  the  inflammation  had 
extended  to  the  base  of  the  finger  while  the  distal  portion,  the 
seat  of  the  disease  when  the  patient  first  came  under  observa- 
tion, presented  a  normal  appearance,  the  skin  being  somewhat 
shrivelled  by  the  action  of  the  alcohol  application, 

AFFECTIONS    OF    THE    RECTUM,    ANUS    AND    ADJACENT    TISSUES. 

Rectal  affections  in  some  form  were  very  common  among  the 
returning  troops  from  Cuba.  It  is  fair  to  presume  that  some 
of  the  soldiers  were  the  subjects  of  a  mild  form  of  hemorrhoids 
when  they  entered  the  service,  but  it  is  equally  certain  that 
none  of  them  were  affected  with  fistula  or  abscess.  To  show 
the  disproportion  of  rectal  disease  between  the  recruits  who 
applied  for  enlistment  and  the  soldiers  returning  from  the 
field,  I  will  state  that  of  10,000  applicants  examined  in  Camp 
Tanner  last  spring  the  following  rectal  affections  were  noted  : 
Hemorrhoids,  internal,  2 ;  external,  219 ;  inflamed,  1 ;  fistula, 
1 ;  prolapsus,  2.  I  attribute  the  prevalence  of  rectal  diseases 
among  our  patients  in  this  camp  to  the  following  causes  :     1, 


215 


intestinal  affections  contracted  in  the  camps  and  Cuba ;  2, 
improper  food  ;  3,  the  relaxing  effect  of  a  tropical  climate ;  4 
frequent  exposure.  Few  of  our  soldiers  escaped  diarrhea  or 
dysentery.  The  irritation  of  the  rectal  mucous  membrane 
could  not  fail  in  many  instances  to  produce  a  catarrhal  proctitis. 
The  inflamed  mucous  membrane  became  permeable  to  the 
passage  of  pathogenic  microbes,  which  so  constantly  infest 
even  the  healthy  rectum.  The  loose  pararectal  connective 
tissue,  under  the  influence  of  general  causes,  became  more  sus- 
ceptible to  infection,  it  is  therefore  not  astonishing  that  we 
should  have  found  so  many  cases  of  perianal,  perirectal  and 
ischiorectal  abscesses  and  their  consequences,  fistulas  Inflam- 
matory affections  of  the  rectum  play  also  an  important  etio- 
logic  role  in  the  development  of  hemorrhoids.  We  found  in  a 
number  of  cases  a  direct  connection  between  an  antecedent 
rectal  inflammatory  affection  and  the  subsequent  appearance 
of  hemorrhoids.  The  intense  tenesmus  which  attends  catarrhal 
proctitis  and  dysentery  causes  muscular  changes  and  lesions  of 
the  mucous  membrane  which  often  become  the  principal  cause 
of  pararectal  inflammation  and  hemorrhoids. 

PARARECTAL    ABSCESS. 

Under  this  head  I  will  report  all  cases  of  suppurative  inflam- 
mation in  the  vicinity  of  the  anus  and  outside  of  the  rectal 
wall  that  have  been  operated  on  in  Camp  Wikoff.  In  all  cases 
the  suppurative  inflammation  pursued  a  very  rapid  course, 
The  pain,  as  a  rule,  was  intense,  and  fluctuation  could  be  felt 
distinctly  in  the  course  of  four  or  five  days.  In  high-seated 
paraproctitis  the  general  symptoms  were  usually  severe,  a  high 
temperature  and  a  rapid  bounding  pulse.  It  was  in  these 
cases  that  the  affection  assumed  the  most  progressive  form. 
The  abscess  contents  were  always  fetid,  otherwise  presented 
the  usual  appearance  of  pus  as  found  in  acute  abscesses  in 
other  localities. 

Case  42.— Robert  F.  Stanley,  age  22,  Troop  (i.  Ninth  Cav- 
alry, colored.  Perianal  and  ischiorectal  abscess.  While  in 
Cuba  had  diarrhea  for  eighteen  days— August  27  to  Septem- 
ber 1— had  chills  and  fever.  Reached  Camp  Wikoff  Septem- 
ber 3,  on  which  day  he  had  pain  about  the  rectum  before  and 
during  defecation  and  on  sitting  down.  He  was  admitted  to 
surgical  ward  September  8.  By  careful  palpation  a  small  area 
of  circumscribed  induration  as  large  as  a  pea  could  be  felt  on 


216 

the  right  side  of  the  sphincter  muscle  and  about  one- third  of 
an  inch  from  the  surface.  This  swelling  could  not  be  detected 
from  the  rectum.  Pain  was  greatly  increased  under  pressure. 
A  small  incision  was  made  and  about  half  a  dram  of  pus 
escaped.  The  little  cavity  was  washed  out  with  peroxid  of 
hydrogen  and  carbolized  water  and  loosely  packed  with  a  strip 
of  iodoform  gauze.  As  an  external  dressing  a  hot  moist  anti- 
septic compress  was  used  and  held  in  place  by  a  T  bandage. 
Immediate  and  almost  complete  relief  followed  the  operation. 
On  the  ninth,  the  temperature  rose  to  100  degrees  F.,  on  the 
tenth  to  101.  The  pain  was  intense  and  referred  to  the  oppo- 
site side  of  the  rectum,  September  10,  a  fluctuating  swelling 
could  be  felt  from  the  perineum  and  the  rectum.  The  abscess 
bulged  externally  as  well  as  on  the  rectal  side.  The  patient 
was  again  anesthetized  and  the  abscess  incised  through  the 
perineum  to  the  left  of  the  median  line.  A  large  quantity  of 
extremely  fetid  pus  escaped.  As  the  undermining  was  exten- 
sive two  counter-openings  were  made,  one  below  and  one  above 
the  first  opening.  Two  fenestrated  rubber  tubes  were  employed 
in  draining  the  large  cavity.  The  abscess  was  washed  out  with 
carbolized  solution  and  peroxid  of  hydrogen,  and  the  moist 
antiseptic  compress  applied.  The  pain  was  relieved  at  once 
and  the  discharge  after  the  operation  slight.  No  tendency  to 
further  undermining,  on  the  other  hand  all  indications  point 
to  an  early  and  permanent  healing  of  the  abscess  cavity. 

It  is  in  cases  like  these  that  practitioners  so  frequently  make 
a  serious  mistake  by  postponing  from  day  to  day  opening  and 
draining  of  the  abscess.  If  we  had  deferred  the  operation  for 
another  day  or  two  the  abscess  would  have  ruptured  into  the 
rectum  and  would  have  led  almost  inevitably  to  the  formation 
of  an  internal  or  complete  fistula.  The  horseshoe  fistulae  fol- 
lowing cases  of  ischio  rectal  abscess,  so  frequently  found  in 
any  of  the  large  surgical  clinics  are  the  best  proof  of  the  neces- 
ity  for  early  operative  interference.  The  rule  should  be  to 
open  such  abscesses  early,  from  the  external  surface,  and  if 
fluctuation  can  not  be  felt  from  this  direction  but  from  the 
rectum,  the  tissues  on  the  side  of  the  rectum  can  be  tunnelled 
with  forceps  after  making  a  superficial  incision,  until  the 
abscess  cavity  is  reached.  The  surgeon  must  so  conduct  the 
treatment  that  the  formation  of  a  fistula  can  be  avoided,  and 
this  can  be  done  in  nearly  all,  if  not  all,  cases  in  which  the 
abscess  is  opened  before  it  ruptures  into  the  rectum. 

Case  43. — Alva  J.  Vananken,  age  27,  Troop  K,  First  Cavalry. 
Perirectal  abscess.  On  his  last  day  in  Cuba  the  patient  had  a 
mild  fever  and  diarrhea  ;  the  latter  persisted  fifteen  or  sixteen 
days.     For  the  last  ten  days  has  had  a  throbbing  pain  in  the 


217 


post  anal  region.  An  abscess  found  and  opened  in  the  median 
line,  between  the  anus  and  coccyx.  Under  ether  anesthesia  the 
abscess  cavity  behind  the  rectum  was  freely  opened  with  the 
Paquelin  cautery,  taking  the  fistulous  opening  in  the  median 
line  as  a  guide  for  the  incision.  The  cavity  was  thoroughly  dis- 
infected and  packed  with  iodoform  gauze,  over  which  the  usual 
moist  dressing  was  applied.  Rapid  healing  of  the  cavity  by 
granulation. 

Case  ii.— Robert  Sylvester,  age  24,  Company  (i,  Fourth 
Artillery.  Has  been  ill  with  typhoid  malarial  fever  while  in 
Cuba.  Returned  from  Cuba  on  the  steamer  Le  )na,  and 
reached  Camp  Wikofif  about  September  1.  Soon  after  his 
arrival  he  noticed  pain  on  the  left  side  of  the  rectum.  The 
pain  and  tenderness  increased  rapidly  in  intensity.  September 
7,  he  was  admitted  to  the  surgical  ward  and  the  operation  was 
performed  without  anesthesia  three  days  later.  At  this  time 
the  abscess  was  prominent  on  the  side  of  the  anus  and  the  over- 
lying skin  presented  an  inflammatory  blush.  Fluctuation 
very  distinct  from  the  rectum  as  well  as  from  the  surface.  The 
abscess  was  opened  by  a  single  incision  and  tubular  drainage 
established,  as  the  incision  was  large  enough  to  serve  for 
drainage.  After  disinfection  of  the  cavity  and  packing  it 
lightly  with  iodoform  gauze,  a  moist  antiseptic  compress  was 
applied.  The  patient  was  very  weak  at  the  time  the  operation 
was  performed,  but  gained  sufficiently  in  strength  in  a  week  to 
warrant  his  transfer  to  a  hospital  in  Philadelphia. 

Case  45. — Joseph  Barret,  age  28,  Third  Infantry,  Company 
G.  Ischio-rectal  abscess.  About  the  time  of  the  surrender  of 
Santiago  had  general  malaise,  fever,  vomiting  and  diarrhea  for 
which  he  has  since  been  on  the  sick  list.  Several  days  ago  he 
began  to  experience  pain  in  the  rectum  which  has  increased 
steadily  since,  and  at  the  time  he  was  admitted  to  the  surgical 
ward  the  ischiorectal  abscess  had  opened  spontaneously  on  the 
right  side  just  within  the  anal  margin.  General  health  much 
improved.  On  August  31,  under  chloroform  anesthesia  the  ab- 
scess cavity  was  distended  with  peroxid  of  hydrogen  for  the 
purpose  of  ascertnning  its  exact  size  and  location.  A  grooved 
director  was  inserted  into  the  fistulous  opening  and  used  as  a 
guide  in  laying  open  the  abscess  cavity  freely  with  tjie  knife 
point  of  the  Paquelin  cautery.  The  abscess  cavity  was  disin 
fected  and  packed  loosely  with  iodoform  gauze  over  which  the 
moist  compress  was  applied.  He  improved  rapidly  after  the 
operation  and  a  few  days  later  was  transferred  to  a  hospital  in 
Boston. 

Case  46.— William  Head,  age  20,  Eighth  Ohio  Infantry, 
Company  G,  enlisted  two  and  a  half  months  ago.  Admitted  to 
the  surgical  ward  with  a  history  of  malarial  fever  and  dysen- 
tery in  Cuba,  followed  by  ischiorectal  abscess  which  discharged 
itself  near  the  anal  orifice  on  the  right  side.  Discharge  con- 
tinues profuse.     The  peroxid  of  hydrogen  test  was  applied  to 


218 

ascertain  the  extent  of  the  abscess  cavity  which  was  found  to 
extend  high  up  into  the  ischiorectal  fossa.  Owing  to  the 
marked  anemia  and  general  debility  a  counter-opening  was 
made  lower  down  and  thorough  drainage  secured,  in  place  of 
opening  the  abscess  cavity  freely  with  the  Paquelin  cautery. 
Chloroform  was  used  as  an  anesthetic.  The  general  and  local 
conditions  improved  promptly  after  the  operation. 


The  spontaneous  rupture  of  a  pararectal  or  ischiorectal  ab- 
scess into  the  rectum  is  generally  followed  by  the  formation  of 
a  fistula.  If  the  abscess  communicates  with  the  rectum  its 
existence  can  be  surmised  from  the  intermittent  discharge  of 
pus  and  local  symptoms  which  refer  to  the  rectal  lesion.  An 
internal  fistula  of  such  an  origin  is  often  made  complete  by  the 
abscess  finding  eventually  an  external  outlet  somewhere  in  the 
anal  region.  An  external  fistula  caused  by  the  opening  of  a 
pararectal  abscess  not  infrequently  becomes  complete  by 
the  destructive  process  penetrating  the  rectal  wall.  I  have 
long  ago  abandoned  the  probe  in  differentiating  between  an  ex- 
ternal fistula  and  a  complete  one.  Injection  of  peroxid  of  hy- 
drogen into  the  cavity  under  pressure  makes  a  positive  diagno- 
sis at  once.  If  the  fistula  is  external  the  abscess  cavity  be- 
comes tense,  if  complete  the  peroxid  foam  enters  the  rectum  and 
will  escape  from  the  anus.  The  probe  is  only  used  after  the 
test  has  made  the  diagnosis  and  then  only  as  an  aid  in  perform- 
ing the  necessary  operation.  In  diagnosticating  the  existence 
and  location  of  an  internal  fistula  the  rectal  speculum  is  of 
the  greatest  importance.  Rectal  fistula  will  be  less  frequently 
met  with  when  the  prof ession  as  a  whole  recognizes  the  import- 
ance of  early  operative  interference  in  cases  of  pararectal  abscess. 
In  my  surgical  work  in  Camp  Wykoff  only  two  cases  of  rectal 
fistula  presented  themselves  for  operative  treatment. 

Case  47. — Lieut.  G.  W.  Goode,  Troop  i,  Ninth  Cavalry. 
Hemorrhoids  and  fistula.  He  was  admitted  to  the  surgical 
ward  August  24.  He  has  been  almost  habitually  constipated, 
and  has  been  much  in  the  saddle.  He  knows  of  no  definite  pre- 
ceding illness  to  account  for  present  condition.  He  has  had 
much  pain  and  bleeding  on  defecation,  pain  persisting  for 
an  hour  or  two  after.  Examination  reveals  large  internal 
and  external  hemorrhoids  and  an  incomplete  internal  fis- 
tula following  the  rupture  of  a  post  rectal  abscess,  into  the 
rectum  through  the  middle  of  the  sphincter  muscle,  posterior 
side.     The  abscess  cavity,  the  size  of  a  walnut,  was  freely  laid 


219 


open  upon  a  grooved  director  with  the  knife  point  of  the  Pa- 
quelin  cautery.  The  incision  was  carried  directly  backward 
through  the  median  line.  The  hemorrhoids,  two  in  number, 
affecting  the  posterior  segment  of  the  anal  ring  were  removed 
by  clamp  and  cautery.  The  abscess  cavity  was  loosely  packed 
with  a  strip  of  iodoform  gauze.  The  rectal  tampon  re- 
mained for  two  days,  The  patient  made  a  rapid  recovery  and 
was  able  to  leave  the  hospital  September  13.  The  agonizing 
pain  attending  and  following  each  bowel  movement  disap- 
peared immediately  after  the  operation. 

Case  48.— John  M.  Boyd,  age  29,  Troop  G,  Third  Cavalry, 
enlisted  four  months  ago.  Admitted  to  the  surgical  de- 
partment of  the  General  Hospital  August  27.  His  health  was 
good  until  he  went  to  Tampa,  June  8.  At  that  time  he  suffered 
from  diarrhea  which  was  persistent,  but  did  not  prevent  his 
doing  duty  in  the  saddle.  For  the  past  five  weeks  and  following 
a  severe  pain  in  the  rectum  which  continued  several  days,  he 
has  noticed  a  discharge  of  pus  from  the  rectum.  The  pain  did 
not  disappear  entirely  after  the  abscess  ruptured  into  the  rectum 
and  was  always  aggravated  during  defecation.  August  28, 
under  chloroform  anesthesia  the  sphincter  ani  was  dilated,  the 
internal  opening  was  found,  the  cavity  distended  with  peroxid 
of  hydrogen,  external  counter  openicg  made  by  the  aid  of  the 
grooved  director  and  the  intervening  tissues  divided  with  the 
Paqueiin  cautery.  Iodoform  gauze  packing  and  dry  dressing. 
The  internal  opening  in  this  case  was  just  above  the  sphincter 
muscle,  the  abscess  on  the  right  side  of  the  rectum.  Rapid 
healing  of  the  abscess  cavity. 

HEMORRHOIDS. 

A  large  number  of  hemorrhoid  cases  came  to  the  surgical 
ward  with  the  desire  and  expectation  of  receiving  the  benefits 
of  a  radical  operation.  I  am  satisfied  that  only  a  small  per- 
centage of  those  affected  were  willing  or  prepared  to  be  sub- 
jected to  an  operation.  Some  of  the  cases  examined  perempto- 
rily declined  to  receive  treatment  knowing  well  that  the  re- 
sults would  put  one  claim  for  pension  beyond  their  reach.  In 
my  capacity  as  operating  surgeon  of  the  camp  I  was  very  anx- 
ious to  curtail  the  list  of  pensioners  of  this  war  by  performing 
operations  for  surgical  affections  which,  if  left  alone,  would 
furnish  a  just  claim  upon  the  Government.  On  the  whole,  I 
found  the  colored  soldiers  much  more  willing  than  their  white 
comrades  to  be  benefited  by  surgery.  They  proved  themselves 
worthy  of  their  hire  in  the  hospital  as  well  as  on  the  battle- 
field. Too  much  can  not  be  said  in  praise  of  our  colored  sol- 
diers.    They  showed  a  staunch  faith  in  their  doctors  as  well 


220 


as  their  commanders,  and  were  ready  at  all  times  to  follow 
their  advice  as  well  as  the  commands  of  their  officers.  Nearly 
all  of  the  hemorrhoids  operated  on  ehowed  pathologic  ap- 
pearances which  demonstrated  their  recent  origin.  In  a  very 
large  percentage  of  cases  the  first  manifestation  of  hemor- 
rhoidal condition  was  preceded  by  intestinal  disturbances, 
diarrhea  or  dysentery.  Fortunately,  I  had  two  Paquelin  cau- 
teries at  my  disposal  as  soon  as  the  operating  tent  was  opened. 
As  I  said  in  the  beginning  of  this  paper,  my  instrumentarium 
at  first  was  a  very  scanty  one.  Instruments,  however,  began 
to  come,  day  after  day,  and  finally  I  had  an  excellent  supply, 
including  a  number  of  cases  for  special  work.  The  absence 
of  a  proper  pile  clamp  from  the  outfit  of  the  surgical  ward  at 
the  outset,  necessitated  the  use  of  something  as  a  substitute. 
This  was  found  in  a  curved  hemostatic  forceps.  Except  for  its 
lightness,  and  therefore  comparatively  inefficient  grasping 
power,  this  answered  the  purpose  admirably.  In  fact,  the 
facility  and  accuracy  with  which  the  hemorrhoidal  swelling 
could  be  clamped  and  isolated,  the  small  space  required  for 
its  use,  and  its  general  convenience  and  ease  of  handling  as 
compared  with  heavy  clamps,  now  in  the  market,  led  to  the 
devising  by  Major  Adams  of  Chicago,  of  a  hemorrhoid  clamp 
similar  to  the  forceps  used,  but  so  constructed  as  to  obviate 
the  defects  of  weakness  and  imperfect  grasp  found  in  that  in- 
strument. The  use  of  the  forceps  as  a  clamp  has  demon- 
strated that  the  amount  of  pressure  and  crushing  exerted  by 
the  old-fashioned  instruments  are  unnecessary  and  uncalled 
for ;  also  that  there  is  no  need  of  ivory  plates  to  prevent  the 
transmission  of  heat  through  the  metal  of  the  forceps  to  the 
underlying  mucous  membrane,  as  in  no  instance  was  any  ill 
effect  observed  from  this  cause.  Another  advantage  of  the 
narrow  blade  forceps  has  been  demonstrated  in  the  absence  of 
any  hemorrhage  whatever  after  operation.  The  new  clamp 
has  blades  with  a  serrated  grasping  surface  5  cm.  long,  curved 
on  the  fiat,  the  width  of  the  blades  closed  is  9  mm.,  their 
thickness  6  mm.,  beveled  away  from  the  upper  to  the  outer 
edge  for  1  mm.  The  object  of  the  bevel  is  to  allow  of  the  oper- 
ation of  the  cautery  with  the  least  possible  contact  with  the 
metal  of  the  clamp,  to  avoid  heating.  The  blades  come  into 
contact  at  the  point  first,  so  that  uniform  pressure  is  exerted 


221 


the  whole  length  of  the  blades  when  closed,  and  the  hemor- 
rhoid can  not  escape  its  grasp  at  the  point,  as  often  happens 
with  the  ordinary  clamp. 

The  handles  are  arranged  like  those  of  a  needle  forceps. 
With  one  exception  the  hemorrhoids  were  removed  with  the 
knife  point  of  the  Paquelin  at  a  dull  red  heat,  after  clamping 
the  swelling  at  its  base.  The  hemorrhoid  was  first  grasped 
with  a  dissecting  or  hemostatic  forceps,  when  the  base  of  the 
cone  elevated  to  the  desired  extent  was  grasped  and  clamped 
with  the  forceps  and  the  mass  outside  of  the  grasp  of  the  in- 
strument shaved  away  with  the  cautery.      The  operation   of 


LATe^Al_yf£VV 


t/ppsRSt^/^PAce 


TfSAN'SVERSE  SeCTIO/V  OF^  BlADES  . 

Hemorrhoid  clamp,  devised  by  Major  Adams. 

removal  was  always  preceded  by  dilatation  of  the  sphincter. 
The  patients  were  always  properly  prepared  for  the  operation 
the  day  before.  The  rectum  was  thoroughly  cleared  out  by 
the  administration  of  a  cathartic  and  irrigation.  The  last 
enema  was  given  on  the  morning  of  the  operation.  As  a  rule, 
two  or  three  seizures  were  made.  After  dilatation  of  the 
sphincter  the  hemorrhoidal  swellings  were  located  and  grasped 
with  forceps  so  that  the  work  of  clamping  and  cauterization 
could  proceed  without  interruption.  Care  was  exercised  in 
every  case  not  to  remove  too  much  tissue  ;  due  allowance  was 
given   for    subsequent     contraction.      The    anal    region    was 


222 


shaved  and  prepared  in  the  same  manner  as  for  operations  in 
other  localities.  One  of  the  principal  sources  of  pain  after 
operations  for  hemorrhoids  has  been  the  protrusion  and  swell- 
ing of  the  cauterized  surfaces.  For  many  years  I  have  suc- 
ceeded in  preventing  this  very  painful  post-operative  complica- 
tion by  resorting  to  drainage  and  rectal  tamponade.  This 
method  of  dressing  rectal  wounds  after  this  operation  is  not 
sufficiently  known  and  practiced.  Those  who  have  not  tried  it 
might  entertain  a  fear  that  it  is  a  source  of  distress  rather 
than  comfort.  Quite  an  extensive  experience  with  this 
method  of  after-treatment  enables  me  to  make  the  unqualified 
statement  that  the  rectal  tampon,  properly  applied,  is  well 
borne  by  the  patients  and  makes  the  use  of  anodynes  superflu- 
ous. I  never  administer  opiates  after  operation  for  hemor- 
rhoids. The  rectal  tampon  not  only  obviates  unnecessary  pain, 
but  it  also  is  almost  an  absolute  protection  against  secondary 
hemorrhage  and  more  than  this,  it  provides  for  free  rectal 
drainage  and  constitutes  the  best  possible  dressing  for  the 
cauterized  surfaces. 

When  I  first  used  this  tampon.  I  was  under  the  impression 
that  it  was  something  new,  but  I  learned  later  that  Mitchell 
Banks  had  used  a  very  similar  contrivance  before.  The  tam- 
pon is  made  by  taking  a  piece  of  rubber  tubing  eight  inches  in 
length  and  inserting  into  it  a  glass  cylinder  three-fourths  of  an 
inch  in  diameter  and  about  2  inches  in  length.  The  glass  tube 
is  placed  where  the  gauze  tent  is  tied  over  the  rubber  tubing 
for  the  purpose  of  furnishing  a  support  to  the  string  with  which 
the  gauze  tent  is  tied  upon  the  tube  and  to  insure  patency  of 
the  tubular  drain.  The  rubber  tube  should  project  well  over 
the  glass  cylinder  on  the  rectal  side.  The  gauze  tent  is  made 
of  one  or  two  layers  of  iodoform  gauze.  After  completion  of 
the  operation  the  tent  is  carefully  folded  and  the  upper  portion 
covered  with  vaseline.  The  tube  is  then  inserted  into  the  rec- 
tum to  the  depth  of  three  or  four  inches  and  the  space  between 
the  tent  and  tube  packed  with  strips  of  iodoform  or  plain  sterile 
gauze.  After  the  required  amount  of  packing  is  inserted  the  tam- 
pon is  pushed  in  the  direction  of  the  rectum  sufficiently  to  bring 
the  pressure  above  the  grasp  of  the  sphincter  muscle.  In  doing 
this  the  projecting  mucous  membrane  and  what  may  remain  of 
the  external  hemorrhoids  are  completely  reduced.     The  gauze 


223 


Rectal  tampon.    Rubber  tube  20  cm.,  glass  tube  8  cm. 


224 


outside  of  the  anal  orifice  is  then  wound  around  the  tube  and 
forms  a  part  of  the  external  dressing.  Over  the  gauze  a  wide 
ring  of  absorbent  cotton  is  applied  and  the  whole  retained  in 
place  by  a  T  bandage.  The  tampon  should  remain  for  24  to  48 
hours. 

In  removing  it  traction  is  made  on  the  gauze  tent  sufficiently 
to  bring  the  packing  within  easy  reach  when  it  is  removed  be- 
fore an  attempt  is  made  to  extract  the  tube.  After  the  removal 
of  the  tampon  the  patient  should  be  given  a  laxative  and  after 
this  has  acted  the  cauterized  surfaces  now  minus  the  eschar 
are  protected  by  applying  carbolated  vaseline  or  some  other 
antiseptic  non  irritating  ointment.  I  have  made  it  a  rule  to 
keep  the  patient  confined  to  bed  for  at  least  a  week,  still  better 
two  weeks.  The  cases  of  hemorrhoids  operated  upon  in  this 
camp  with  very  few  exceptions  have  been  men  whose  general 
health  was  much  impaired,  yet  in  every  case  the  wounds  healed 
quickly  and  in  the  most  satisfactory  manner  under  the  treat- 
ment outlined  above. 

Case  49.— M.  J.  McXulty,  age  31,  Company  D,  Sixteenth 
Infantry,  enlisted  six  months  ago.  Has  had  small  hemorrhoids 
for  two  years,  causing  inconvenience  only  after  heavy  drinking. 
In  June,  while  in  Florida,  bleeding  at  stool  occurred  for  the 
first  time.  Since  he  suffered  from  malarial  fever  and  diarrhea 
during  the  Cuban  campaign,  he  has  suffered  from  profuse 
bleeding  on  defecation.  Septembers,  under  chloroform  anes- 
thesia, three  hemorrhoidal  swellings  were  removed. 

Case  .30.— George  Morton,  age  47,  sergeant  Ninth  Cavalry, 
Troop  A,  colored,  has  been  in  the  service  ten  years  and  seven 
months.  Had  dysentery  two  months  ago,  since  then  has  suf- 
fered from  pain  in  the  rectum  and  bleeding  with  each  evacua- 
tion of  the  bowels.  August  26,  under  chloroform  anesthesia, 
three  hemorrhoids,  partly  external  and  partly  internal,  were 
removed  by  clamp  and  cautery. 

Case  oi.— Jesse  Donaldson,  age  30,  Troop  M,  Ninth  Cavalry, 
colored,  enlisted  three  months  ago.  While  in  Tampa,  patient 
suffered  from  malarial  fever  and  diarrhea,  the  latter  continued 
for  three  or  four  days.  Has  not  been  well  since  that  time. 
Since  August  1,  he  has  been  much  inconvenienced  by  a  hemor- 
rhoidal affection  which  developed  recently.  Operation  per- 
formed under  chloroform  narcosis,  September  2.  Three  inter- 
nal hemorrhoids,  two  posteriorly,  one  at  upper  right  quadrant, 
were  removed  in  the  usual  way  by  clamp  and  cautery. 

Case  5i'.— Claude  F.  Hall,  age  23,  Company  G,  Sixteenth 
Infantry,  had  hemorrhoids  about  four  years  ago,  but  not  so 
severe  an  attack  as  the  present.    Recovered  without  operation. 


225 


Has  been  in  the  service  since  the  17th  of  September,  a  year 
ag:o.  Following  an  attack  of  malaria  and  diarrhea  in  Cuba,  he 
has  been  suffering  from  hemorrhoids  for  the  past  six  weeks. 
He  has  no  bleeding,  but  the  hemorrhoids  have  been  protruding 
constantly  and  are  very  painful.  September  7,  under  chloro- 
form anesthesia,  three  internal  hemorrhoids  were  removed  in 
the  usual  manner  by  clamp  and  cautery.  They  were  located 
respectively  in  the  posterior  right  and  left  quadrant. 

Case  52. — James  Jervis,  age  19,  Compaoy  K.  Thirty  fourth 
Michigan  Infantry,  enlisted  three  and  a  half  months  ago.  Had 
diarrhea  two  weeks,  before  leaving  Cuba.  Has  had  much  pain 
and  bleeding  with  movements  of  bowels  since.  Never  had  rec- 
tal trouble  of  any  kind  before.  August  31,  under  ether  anes- 
thesia, two  internal  hemorrhoids  were  removed. 

Case  55. —Ora  Keithley,  age  23,  Troop  M,  First  Vol.  Cavalry, 
first  suffered  severe  pain  from  hemorrhoids  in  July,  when  on 
duty  in  Cuba.  He  had  had  previously  an  attack  of  rheuma- 
tism from  exposure  to  rough  and  wet  weather  and  sleeping  on 
wet  ground.  On  September  7,  three  hemorrhoids,  partly  ex- 
ternal and  partly  internal,  were  removed. 

Case  Ji.— Horace  Carden,  age  21,  Troop  M,  First  Vol.  Cav- 
alry, has  suffered  off  and  on  for  three  years  from  hemorrhoids, 
the  present  attack  was  not  preceded  by  any  bowel  complaint  or 
other  illness.  Has  had  no  bleeding,  but  much  pain  and  itch- 
ing. Operation  under  chloroform  anesthesia,  September  8, 
when  three  internal  hemorrhoids  were  removed. 

Coseol.— Silas  McGovern,  age  28,  Troop  A,  Ninth  Cavalry, 
colored,  has  been  in  the  service  three  years.  Patient  was  ad- 
mitted to  the  surgical  ward  September  3,  One  week  ago, 
directly  following  an  attack  of  diarrhea,  he  noticed  pain  in  the 
rectum  on  defecation.  The  mucous  membrane  of  the  rectum 
protruded  with  each  stool.  Day  after  admission  the  patient 
was  chloroformed  and  three  internal  hemorrhoids  were  re- 
moved. The  appearance  of  the  swellings  indicated  their  recent 
origin.  The  mucous  membrane  was  in  a  state  of  catarrhal 
inflammation.  The  posterior  half  of  the  anal  ring  was  princi- 
pally affected  by  the  hemorrhoids  as  well  as  by  the  catarrhal 
inflammation. 

Cam  5^,— Joseph  Etter,  aged  19,  Troop  I,  Ninth  Cavalry, 
colored,  has  suffered  for  the  past  two  months  from  hemorrhoids 
which  he  believes  were  brought  on  by  heavy  lifting.  Since  the 
supposed  "strain"  he  has  experienced  severe  burning  pain 
with  each  movement  of  bowels  and  profuse  bleeding.  Pain  has 
been  persistent  after  stools  for  several  hours.  September  8, 
under  chloroform,  three  large,  dark-blue  hemorrhoids  were 
found,  one  on  right  and  left  side  posteriorly,  and  one  on  ante- 
rior left  quadrant.  The  swellings  were  removed  as  usual  by 
the  use  of  clamp  and  Paquelin  cautery. 

Case  37.— Lee  Shanks,  age  26,  Troop  A,  First  Vol.  Cavalry, 
has  been  in  the  service  three  months.     He  has  been  suffering 


226 


from  hemorrhoids  for  the  past  month  with  no  illness  preceding. 
He  has  had  much  pain  after  defecation,  but  no  bleeding. 
Under  chloroform  three  external  hemorrhoids  were  removed, 
September  2.  One  of  the  swellings  occupied  the  posterior  wall 
of  the  rectum  to  the  right  of  the  median  line,  one  to  the  left 
of  the  median  line  posteriorly,  and  the  third  in  the  anterior 
left  quadrant.  The  hemorrhoids  were  disposed  of  in  the  usual 
manner. 

Case  58. — Corporal  Samuel  H.  Edwards,  Troop  C,  First  Cav- 
alry, began  to  suffer  from  profuse  bleeding  on  defecation  the 
latter  part  of  July,  following  an  attack  of  diarrhea  while  on 
duty  in  Cuba.  Pain  has  not  been  severe  at  any  time.  Sep- 
tember 10,  under  chloroform  anesthesia,  four  very  large  inter- 
nal hemorrhoids  were  removed  by  clamp  and  cautery,  two 
from  either  side  of  the  median  line  anteriorly.  The  hemor- 
rhoids in  this  case  were  distinctly  venous,  the  swellings  being 
composed  of  ectatic  veins  almost  exclusively. 

Case  oS*.— Henri  Meuronval,  age  4.3,  Company  F,  Second 
Volunteer  Engineers,  has  suffered  from  hemorrhoids  since 
puberty,  with  exacerbations  at  varying  intervals.  Recently 
much  pain  and  bleeding.  Examination  under  chloroform, 
September  11,  revealed  a  large  internal  venous  hemorrhoid  on 
the  right  side,  which,  owing  to  the  fact  that  the  Paquelin 
cautery  did  not  work  that  day,  was  treated  by  ligature.  Before 
the  silk  ligature  was  applied,  the  mucous  membrane  at  the 
base  of  the  swelling  was  incised.  An  ulcer  as  large  as  a  dime 
was  detected  directly  over  the  sphincter  muscle  in  the  median 
line  and  posterior  surface.  This  ulcer  was  evidently  the  remote 
result  of  a  retroanal  abscess  which  occurred  a  year  ago.  Since 
that  time  the  pain  during  and  after  defecation  has  been  much 
more  severe.  Besides  stretching  the  sphincter,  preliminary  to 
ligation  of  the  hemorrhoid  the  superficial  fibers  of  the  sphinc- 
ter muscle  were  divided,  carrying  the  incision  through  the 
center  of  the  anal  ulcer.  Rectal  tamponade  as  usual.  The 
pain  was  relieved  promptly  by  the  operation. 

Case  6'0.— Capt.  Nat  Phister,  age  44,  Company  G,  First 
Infantry,  has  had  attacks  of  hemorrhoidal  distress  in  1888  and 
1893  but  not  so  severe  as  at  the  present  time.  He  has  suffered 
severely  with  present  attack  since  August  19,  the  exciting 
cause  being  constipation.  The  suffering  was  much  aggravated 
by  a  long  ride  in  the  saddle  which  he  was  compelled  to  take 
while  the  hemorrhoids  were  prolapsed.  Since  that  time  has 
had  severe  pain  and  constant  muco  sanguinolent  discharge, 
necessitating  the  wearing  of  a  diaper.  Under  chloroform  a 
medical  operation  was  performed  September  8,  consisting  in 
the  removal  of  two  large  hemorrhoids,  largely  external,  and 
affected  by  extensive  excoriations.  The  operation  afforded  the 
desired  prompt  relief. 

Case  67. -John  M.  Dixon,  age  40,  Company  B,  First  Infan- 
try, had  an  operation  seven  years  ago  and  had  no  trouble  after 


227 


that  until  about  the  first  of  August,  when  after  a  prolonged 
attack  of  dysentery  he  began  to  suffer  with  prolapse  of  the 
rectum.  He  has  been  in  the  service  seventeen  years  and  when 
last  attack  occurred  he  was  in  Cuba.  He  reached  Camp 
Wikoff  September  13.  He  has  been  greatly  debilitated  by  the 
dysentery,  and  the  prolapse  occurs  whenever  he  assumes  the 
erect  position  or  attempts  to  walk.  Has  much  constant  dis- 
tress with  pain,  smarting,  itchiog  and  occasionally  bleeding. 
Under  anesthesia  operation  was  performed  September  14.  A 
large  hemorrhoid  was  removed  from  the  posterior  aspect  of  the 
rectal  wall  and  a  vertical  strip  of  mucous  membrane  by  clamp 
and  cautery.  A  smaller  swelling  and  strip  of  mucous  mem- 
brane were  removed  from  the  left  quadrant  in  a  similar  man- 
ner. Rectal  tamponade.  Strict  directions  were  given  that  the 
patient  should  be  kept  in  the  recumbent  position  for  at  least  a 
week. 

Case  62. — James  Skinner,  age  28,  Troop  H,  Ninth  Cavalry, 
colored,  was  sick  in  Cuba  with  dengue  fever,  about  twenty 
days,  beginning  about  July  14.  Recovered  only  partially  from 
this  before  (beginning  August  14)  he  had  an  attack  of  malarial 
fever  lasting  fifteen  days.  During  both  attacks  he  had  poig- 
nant diarrhea.  During  the  early  stage  of  malaria  the  hemor- 
rhoids appeared,  with  much  pain,  prolapses  and  bleeding.  On 
September  13,  under  ether  narcosis,  two  internal  hemorrhoids 
were  removed  from  the  posterior  wall  of  the  rectum  middle 
line,  and  the  right  posterior  quadrant.  Patient's  health  much 
impaired,  anemia  marked. 

Case  63.  — John  HoUoman,  age  22,  Troop  B,  Ninth  Cavalry, 
colored,  has  always  been  in  good  health  until  the  latter  part  of 
July,  when  he  had  diarrhea  for  three  days  while  on  duty  in 
Georgia.  Since  then  he  has  had  pain  on  defecation,  prolapse 
of  the  bowel  and  sensation  of  incomplete  evacuation,  but  no 
bleeding.  September  15,  the  patient  was  etherized  and  four 
internal  hemorrhoidal  masses  removed  by  clamp  and  cautery. 

Case  64. — Abraham  Hill,  Company  C,  Twenty-fourth  Infan- 
try, colored,  has  been  in  the  service  twelve  years.  About  eight 
years  ago  he  had  hemorrhoids,  which  were  operated  on  success- 
fully. For  the  past  three  months,  while  on  duty  in  Cuba,  he 
has  been  suffering  great  pain  on  defecation  and  slight  bleeding. 
Rectal  prolapse  at  stool,  always  easily  reduced.  Has  enjoyed 
fair  health  and  attributes  the  attack  to  the  heat  and  dampness 
of  the  Cuban  climate.  Operation  under  chloroform  anesthesia 
performed  September  16.  Three  very  large  internal  hemor- 
hoids,  located  posteriorly  and  laterally,  were  removed  in  the 
usual  way  by  the  clamp  and  cautery. 

The  cases  related  above  are  instructive  in  showing  what  kind 
of  surgery  may  be  expected  among  soldiers  who  have  partici- 
pated in  a  campaign  in  a  tropical  country,  subject  to  its  indi- 
genous diseases  and  debilitated  by  its  climate,  improper  food 


228 


and  exposures.  The  results  obtained  must  also  counsel  the 
military  surgeons  to  practice  their  art  not  only  on  the  battle- 
field, but  also  for  surgical  lesions  caused  independently  of 
wounds  and  so  often  overlooked  in  the  field  hospitals.  I  have 
to  record  only  two  deaths,  and  both  patients  were  operated  on 
in  the  wards  of  the  general  hospital,  being  too  weak  to  be 
transferred  to  the  surgical  ward.  Both  of  them  were  low  with 
typhoid  fever  complicated  by  large  metastatic  abscess,  in  one 
the  parotid,  in  the  other  the  submaxillary  being  involved. 
One  died  the  next  day  after  incision  and  drainage,  the  other 
on  the  third  day.  1  am  satisfied  that  many  of  our  cases  of 
phlegmonous  and  typhoid  abscesses  would  have  died  without 
timely  and  thorough  surgical  interference.  In  many  of  the 
other  cases,  more  especially  hemorrhoids  and  fistula,  the  oper- 
ations performed  will  restore  the  men,  with  the  aid  of  proper 
general  treatment,  to  their  usual  condition,  and  cut  them  off 
from  the  pension  list.  In  all  aseptic  cases  the  wounds  healed 
by  primary  intention,  the  best  possible  proof  that  good  surgi- 
cal work  can  be  done  in  an  operating- tent  in  the  field,  and  with 
very  limited  facilities  for  carrying  out  aseptic  precautions. 
Since  writing  the  above  paper,  a  number  of  interesting  surgi- 
cal cases  have  been  operated  on  in  the  surgical  ward,  which  I 
will  now  report  under  the  head  of 

MISCELLANEOUS    CASES. 

Case  60.— Edward  J.  Hill,  aged  23,  Troop  I,  Ninth  Cavalry, 
colored,  enlisted  three  months  ago.  Painful  tetanoid  spasm 
following  gunshot  wound  of  heel.  About  two  months  ago, 
while  in  Tampa,  accidentally  shot  himself  through  the  left 
heel  with  a  Krag- Jorgensen  carbine  (30  cal. ),  The  bullet  passed 
transversely  in  an  oblique  direction  through  the  os  calcis. 
There  is  no  evidence  of  comminution  of  the  bone,  the  contour 
being  well  preserved  and  the  surfaces  smooth.  While  under 
treatment  for  the  wound,  he  thinks  he  contracted  "rheuma- 
tism in  both  loins."  He  has  suffered  twice  from  painful  teta- 
noid spasm  of  the  gastrocnemius,  the  attacks  lasting  about 
three  hours,  then  subsiding  as  suddenly  as  they  came  on  and 
leaving  the  leg  painless  and  useful.  He  entered  the  hospital 
August  28,  suffering  from  a  third  attack  which  lasted  more 
than  twenty-four  hours,  subsiding  suddenly  during  the  night 
after  his  admission.  The  gastrocnemius  is  firmly  contracted, 
the  heel  raised,  and  any  attempt  to  extend  the  foot  aggravated 
the  pain.     No  tenderness  of  heel  or  scars. 

Case  66. — Wade  H.  Bell,  age  21,  Company  A,  Sixteenth  In- 


229 


fantry,  enlisted  May  23.  He  haubeen  troubled  with  varicocele 
for  the  past  two  months.  It  causes  soreness  and  pain  on  walk- 
ing any  distance,  incapacitating  him  for  guard  duty,  and  he 
believes  the  difficulty  is  gradually  increasing.  He  first  noticed 
the  varicocele  when  he  was  sick  first  with  malarial  fever  for 
five  days.  Had  three  such  attacks.  Veins  nearly  the  entire 
length  of  the  cord  much  dilated  and  tender  on  pressure.  Oper- 
ation by  excision  under  chloroform  anesthesia,  September  5. 
Transverse  suturing  of  the  external  wound  to  shorten  the  elon- 
gated scrotum. 

Case  67.— James  H.  Hebel,  age  21,  Battery  3.  Fourth  Artil- 
lery, enlisted  three  and  a  half  months  ago.  Purulent  ophthal- 
mia and  perforative  keratitis.  On  Saturday,  August  27,  he  felt 
sensation  of  a  foreign  body  in  the  right  eye.  The  next  day 
profuse  purulent  discharge.  On  examination  August  31,  the 
conjunctiva  was  found  intensely  swollen  and  vascular,  dis- 
charge of  pus  profuse,  eyelids  swollen  and  edematous,  pupil 
contracted  ;  beginning  of  ulceration  near  the  center  of  the 
cornea ;  beginning  pannus,  intense  photophobia.  There  is  no 
trace  of  gonorrheal  infection.  The  treatment  consisted  of  fre- 
quent cleansing  with  boracic  acid  solution  and  application  of 
ice.  Atropin  could  not  be  secured  for  three  days.  After  that 
time  it  was  used  in  sufficient  strength  to  dilate  the  contracted 
pupil.  In  spite  of  all  that  could  be  done,  the  corneal  ulcer 
perforated  and  the  anterior  chamber  of  the  eye  was  partially 
evacuated.  At  this  time  the  patient  obtained  a  furlough  and, 
on  his  own  responsibility,  undertook  the  journey  to  his  home 
in  Chicago.  He  was  advised  to  place  himself  on  his  arrival 
under  the  care  of  Professor  Hotz. 

Case  08.— George  Slate,  age  24,  civilian.  Habitual  disloca- 
tion of  the  left  shoulder  joint.  This  is  the  sixth  time  during 
the  last  two  years  the  accident  occurred.  Patient  probably 
under  the  influence  of  liquor  when  injured,  as  he  does  not 
know  how  it  happened.  Became  aware  of  the  dislocation  on 
waking  up  in  the  morning.  Several  contusions  on  other  parts 
of  the  body  were  discovered.  Dislocation  of  head  of  humerus 
downward  and  forward  underneath  coracoid  process  of  the 
scapula.  On  request  of  the  patient  chloroform  was  adminis- 
tered, and  the  luxation  reduced  very  easily  by  extension  and 
rotation.  The  arm  was  immobilized  by  a  Velpeau  bandage. 
Accident  September  15,  reduction  the  following  forenoon. 

Case  (J9. — Peter  Hansen,  age  32,  farrier,  Troop  L,  First  Cav- 
alry, fell  from  stumbling  horse  September  15,  in  such  a  way 
that  he  struck  the  ground  with  his  left  shoulder.  He  has 
been  unable  to  raise  his  arm  since.  Carries  affected  shoulder 
lower  than  the  opposite  one.  Pain  and  circumscribed  tender- 
ness over  the  clavicle  about  an  inch  from  the  acromio-clavic- 
ular  articulation.  Patient  somewhat  obese,  so  that  the  distal 
side  of  the  clavicle  can  not  be  readily  traced.  Fracture  of  the 
clavicle  near  the  accromion   process  was  diagnosticated,  al- 


230 


though  no  distinct  displacement  could  be  made  out  or  crepi- 
tus elicited.     Arm  supported  in  a  mitella. 

Case  70. — Edward  Conean,  age  24,  Troop  I,  Ninth  Cavalry, 
colored.  Enlisted  four  months  ago.  Admitted  to  the  surgical 
ward  September  7,  with  swelling  and  extreme  tenderness  of 
anterior  surface  of  the  left  tibia.  Previous  diagnosis  of  osteo- 
myelitis had  been  made.  Xo  history  of  injury.  The  swelling 
is  most  marked  over  the  central  portion  of  the  shaft  of  the 
bone.  The  onset  of  the  disease,  the  location  and  character  of 
the  swelling  and  the  nocturnal  exacerbations  of  the  pain  left 
no  doubt  as  to  the  syphilitic  nature  of  the  periostitis.  Inquiry 
develops  a  history  of  primary  syphilis  four  years  ago.  Has  had 
secondary  eruptions  and  mucous  plaques,  etc.,  and  at  the 
present  time  there  is  hyperplasia  of  the  lymphatic  glands  in 
all  the  principal  accessible  regions. 

Rest  in  bed.  elevation  of  limb,  hot,  moist,  antiseptic  com- 
press and  the  internal  use  of  potassic  iodid  in  15  grain  doses, 
four  times  a  day  constituted  the  treatment  that  was  directed. 
Under  the  iodid  the  pain  and  tenderness  diminished,  as  well 
as  the  swelling.  A  few  days  after  his  admission  a  small 
fluctuating  swelling  could  be  felt  in  the  center  of  the  inflamed 
area,  but  as  no  pus  was  expected  the  use  of  the  knife  was 
refrained  from.  This  superficial  central  softening  is  often  seen 
in  gummatous  swellings  and  will  disappear  under  the  treatment 
the  patient  is  receiving  now.  If  absorption  of  the  liquid  con- 
tents of  the  fluctuating  swelling  does  not  take  place,  tapping 
and  washing  out  with  a  5  per  cent,  solution  of  carbolic  acid 
will   be  resorted  to. 

Case  71.— Ij.  J.  Torney,  age  '21,  Troop  D,  Sixth  Cavalry,  has 
been  in  the  service  two  years  and  four  months.  Pressure  paral- 
ysis of  radial  nerve.  While  in  Cuba  was  in  the  hospital  three 
days  for  chills  and  fever.  He  joined  his  command  after  his 
discharge  from  the  hospital  and  was  quite  well  for  three  weeks, 
when  suddenly  he  became  unconscious  and  was  afterward 
wildly  delirious  and  had  to  be  tied  to  a  litter  for  safe  trans- 
portation. During  this  trip  he  lost  the  use  of  the  extensor 
muscles  of  the  right  hand.  The  paralysis  remains  complete, 
otherwise  the  patient  is  in  fair  condition,  although  occasion- 
ally the  temperature  rises  to  102  F.  The  patient  is  not  con- 
fined to  bed.  The  paralysis  of  the  musculo  spinal  nerve  was 
undoubtedly  caused  by  pressure  during  the  transportation  on 
the  litter.     Massage  and  electricity  were  advised. 

Case  72. — Thomas  Clemens,  age  21,  recruit.  Twenty  fourth 
Infantry,  enlisted  two  months  ago.  Hydrocele  of  the  cord. 
Came  to  the  surgical  ward  for  diagnosis  September  16.  Six 
months  ago,  while  in  the  act  of  lifting  a  heavy  box,  was  taken 
rather  suddenly  with  pain  in  the  right  side  of  the  scrotum. 
In  a  few  days  a  swelling  developed,  the  size  of  a  hazelnut,  which 
has  remained.  The  swelling  is  tender  to  the  touch  and  is  con- 
nected with  the  cord  about  an  inch  above  the  epididymis.    The 


231 


swelling  ie  circumscribed  and  fluctuates   distinctly.     It  was 
diagnosticated  as  a  hydrocele  of  the  cord. 

APPENDICITIS. 

It  is  somewhat  astonishing  that,  in  these  days  of  appendi- 
citis rage,  of  the  many  thousand  soldiers  who  have  landed  at 
Montauk,  not  one  case  of  appendicitis  came  under  my  notice 
that  would  have  justified  an  operation.  We  would  naturally 
expect  that  among  such  a  large  body  of  men,  almost  all  of 
them  at  some  time  during  the  last  five  months  the  victim  of 
intestinal  affections,  the  appendix  should  have  claimed  its 
good  share  of  disease.  The  climate,  the  diet,  the  previous 
intestinal  affections  contracted  in  Cuba,  should  have,  accord- 
ing to  our  ideas  of  the  nature  of  appendicitis,  combined  in 
exciting  the  disease.  But  such  was  not  the  case.  The  profes- 
sion is  well  aware  of  the  fact  that  surgeons  who  can  see  noth- 
ing else  but  appendicitis  in  cases  in  which  the  patients  com- 
plain of  pain  in  the  right  iliac  fossa,  have  performed  laparot- 
omy, and  these  cases  were  not  few  in  number,  where  as  an 
excuse  for  their  error  in  diagnosis,  they  have  completed  the 
operation  by  removing  a  normal  appendix.  Of  the  three  cases 
of  supposed  appendicitis  sent  to  the  surgical  ward,  in  only  one 
the  diagnosis  proved  correct,  and  this  case  was  such  a  mild  one 
that  an  operation  was  not  deemed  justifiable.  One  proved  to 
be  malaria,  and  the  third  typhoid  fever. 

Case  IS. — Charles  W.  Dyer,  age  19,  Company  K,  Seventh 
Infantry,  has  been  in  the  service  only  six  weeks.  He  was  taken 
sick  September  11,  and  was  transferred  to  the  surgical  ward 
three  days  later.  The  attack  commenced  with  a  chill  and 
some  fever,  the  following  day  pain  in  the  right  iliac  region  set 
in.  Bowels  constipated,  no  vomiting,  loss  of  appetite.  Had  a 
similar  attack  a  year  ago,  from  which  he  recovered  in  a  few 
days.  On  his  admission  to  the  surgical  ward  there  was  slight 
tenderness  over  the  appendix  and  cecum,  no  tympanites  and 
no  palpable  swelling  or  muscular  rigidity,  temperature  only  a 
degree  above  normal.  Catarrhal  appendicitis  was  diagnosti- 
cated, complicated  probably  by  a  similar  condition  of  the 
cecum.  Rest  in  bed,  liquid  diet  and  Ounce  doses  of  equal 
parts  of  castor  oil  and  sweet  oil,  four  hours  apart,  until  the 
bowels  move,  constituted  the  treatment,  under  which  the 
patient  recovered  in  a  few  days. 

Case  7i.— James  Reid,  age  21,  Company  I,  Seventh  Infantry, 
has  been  in  the  service  three  months.  Was  admitted  to  the 
surgical  ward  September  1,  with  the  diagnosis  of  appendicitis. 


232 


The  clinical  history,  as  well  as  his  condition  at  the  time  of 
admission,  warranted  a  change  in  the  diagnosis  from  appendi- 
citis to  typhoid  fever.  The  temperature  was  erratic,  showing 
malarial  complication,  but  the  curve  from  day  to  day  showed 
the  typhoid  part  to  our  satisfaction.  The  tongue  was  brown 
and  dry  with  red  tip  and  margins.  Pulse  100  and  temperature 
at  that  time  varied  from  101  to  105  F.  Abdomen  tympanitic 
and  great  tenderness  in  the  right  iliac  fossa.  Numerous  rose 
spots  appeared  on  the  abdomen  next  day.  Under  appropriate 
treatment  the  fever  subsided  gradually  at  the  end  of  the  third 
week  of  his  illness.  .The  great  tenderness  in  the  right  iliac 
fossa  undoubtedly  led  originally  to  a  wrong  diagnosis,  but  it 
simply  indicated  in  this  case  deep  typhoid  ulcers  in  the  lower 
portion  of  the  ileum. 

Case  15. — Martin  G.  Norman,  age  27,  Seventh  Infantry, 
Company  C,  enlisted  three  months  ago.  On  leaving  Santiago 
he  began  to  feel  bad  with  headache,  anorexia  and  malaria ; 
became  worse ;  lost  sleep  and  complained  of  pain  in  the  stom- 
ach ;  most  severe  on  left  side  under  costal  arch ;  bowels  con- 
stipated, tongue  large,  flabby,  with  indented  margin.  Spleen 
markedly  enlarged.  At  times  has  had  pain  in  cecal  region 
which  disappeared  promptly  after  the  administration  of  a  laxa- 
tive.    Under  quinin  this  patient  improved  rapidly. 

STRICTURE    OF    THE    URETHRA. 

Case  16. — H.  J.  Ewing,  age  54,  Company  A,  Ninth  Infantry, 
has  been  in  the  service  twenty-eight  years.  Admitted  to  the 
surgical  hospital  September  12,  and  transferred  the  next  day 
to  a  hospital  in  New  York,  Has  suffered  from  stricture  of  the 
urethra  for  a  number  of  years.  Exploration  with  the  olive 
pointed  bougie  reveals  a  small  and  tight  stricture  in  the  mem- 
branous portion  of  the  urethra.  The  cause  of  the  stricture  is 
a  fall  upon  the  perineum  he  sustained  in  1864.  Denies  ve- 
nereal infection  of  any  kind.  Of  late  years  he  has  had  at- 
tacks of  stoppage  of  the  urine.  The  stream  is  small  and  mic- 
turition frequent.  Patient  transferred  to  New  York  for  treat- 
ment. 

Case  77.— Prank  Hugh  Banks,  age  20,  Ninth  Cavalry,  Troop 
D,  enlisted  three  months  ago.  Has  had  several  attacks  of 
gonorrhea,  the  last,  two  months  ago.  The  stricture  for  which 
he  was  admitted  to  the  surgical  ward  September  1  involved 
the  membranous  portion  of  the  urethra,  was  an  old  one  and 
was  much  improved  before  he  was  transferred  on  the  8th  to 
his  command.  By  carefv'  and  prolonged  attempts  a  No.  8 
bougie  passed  the  stricture.  The  treatment  consisted  of  grad- 
ual dilatation. 

Case  18. —T.  C.  Mark,  age  29,  Thirteenth  Signal  Corps,  en- 
listed three  months  ago.  Has  stricture  of  the  urethra  dating 
back  to  gonorrhea  two  or  more  years  ago.  Examination  made 
September  14  shows  stricture  half  an  inch  back  of  the  meatus 


238 

A  14;  another  just  in  front  of  the  scrotum  admitting  A  12. 
Gradual  dilatation  wa3  commenced,  but  patient  was  trans- 
ferred to  a  hospital  in  Boston  two  days  later  for  further  treat- 
ment. 

The  few  cases  of  gonorrhea,  syphilis  and  stricture  observed 
in  Camp  Wikoflf  speak  well  for  the  morality  of  our  army. 

ADDITIONAL    CASES    OF     FRACTURE. 

Two  cases  of  fracture  of  the  long  bones  occurring  in  men 
belonging  to  the  Cuban  Army  are  of  interest  in  showing  im- 
paired nutrition  as  one  of  the  causes  of  delayed  or  non- union. 

Case  79. — Hillyard  H.  Felder,  age  44,  packer,  not  enlisted. 
Five  weeks  ago,  in  Cuba,  fell  from  a  freight  wagon ;  jumped 
to  save  himself  and  landed  on  his  feet  in  a  small  hole,  twisting 
his  legs.  He  sustained  a  transverse  fracture  of  the  right  tibia 
about  an  inch  above  the  base  of  the  inner  malleolus,  and  a 
transverse  fracture  through  the  middle  of  the  external  malle- 
olus. He  came  to  the  surgical  ward  September  14,  the  left 
limb  in  lateral  splints,  the  right  in  plaster  of  Paris  bandage. 
None  of  the  fractures  of  the  right  leg  have  united,  and  there 
are  no  signs  of  formation  of  provisional  callus.  Fracture  of 
left  fibula  united  with  some  deformity.  Patient  is  over  six 
feet  in  height  and  very  much  emaciated.  Plaster  of  Paris 
bandage  renewed  on  right  limb  ;  no  dressing  for  the  left  one. 
Operation  for  non-union  of  fracture  of  tibia  advised  as  soon 
as  the  patient's  general  condition  is  improved. 

Case  80. — John  Coleman,  age  28,  Irish,  stevedore,  employed 
at  the  dock,  Montauk  harbor.  Admitted  during  the  afternoon 
September  12,  to  the  surgical  ward.  While  handling  lumber 
was  struck  on  right  side  of  face  by  a  crowbar  handle  set  in  mo- 
tion by  the  slipping  of  a  wrench.  The  accident  occurred  an 
hour  before  his  admission  to  the  hospital.  The  patient  was 
unconscious  and  very  restless.  Right  side  of  face  swollen. 
Two  small  wounds  had  been  sutured  before  he  entered  the  hos- 
pital. Exophthalmos  of  right  eye  caused  by  retro-bulbar  hem- 
orrhage, divergent  strabismus  and  dilatation  of  pupil,  which 
does  not  respond  to  light.  Free  hemorrhage  from  mouth  ;  no 
hemorrhage  or  serum  discharge  from  either  ear.  Through  the 
swollen  part  of  the  cheek  the  malar  bone  could  be  distinctly 
moved  and  crepitus  was  distinct.  Pulse  60.  Xo  paralysis. 
Fracture  of  the  malar  and  superior  maxilla  with  extension  of 
lines  of  fracture  through  the  base  of  the  skull  was  diagnosti- 
cated. On  the  second  day  the  patient's  condition  was  very 
much  improved  but  toward  evening  a  rapid  rise  in  temperature 
led  to  a  careful  search  for  the  cause  of  the  fever.  Professor 
Delafield  was  called  into  consultation  and  found  a  right  lobar 
pneumonia. 

Since  leaving  the  camp  I  have  been  informed  by  Dr.   Green- 


234 


leaf  that  the  pneumonia  terminated  in  a  typic  crisis  at  the 
usual  time,  and  that  the  patient  is  recovering  rapidly  from  the 
injury. 

Case  81. — Charles  Lubbas,  age  44,  German,  engineer.  Frac- 
ture of  the  clavicle.  A  week  ago  while  at  work  as  engineer  on 
the  Vigilanc'ia,  was  struck  on  the  right  shoulder  by  a  falling 
plank  producing  a  fracture  of  the  clavicle  at  the  junction  of 
the  outer  with  the  middle  third.  The  fracture  was  oblique, 
the  internal  fragment  displaced  upward  and  forward  and  some 
overlapping.  Reduction  and  Sayre- Velpeau  dressing.  Patient 
was  transferred  the  same  day  to  New  York. 

ADDITIO>'AL  CASES  OF    GU>'SHOT  I>'JURIES. 

Case  82. — Peter  Carr,  aged  40,  sergeant  Company  F,  Six- 
teenth Infantry.  In  service  16  years  and  nine  months.  Was 
wounded  July  2  before  Santiago.  He  fell  down  at  once  on  re- 
ceipt of  the  injury,  and  on  trying  to  arise  found  that  the  left 
leg  was  paralyzed  both  as  to  sensation  and  motion.  He  was 
carried  to  the  First  Division  Hospital  where  the  wound  was 
dressed  and  he  remained  four  days,  thence  to  Siboney  where  he 
staid  three  days  before  being  taken  on  board  Hospital  Ship 
Relief.  He  was  landed  from  the  i^e/ie/ at  Governor's  Island, 
has  had  a  furlough  of  thirty  days  and  on  Sept.  16  reported  for 
duty  at  Camp  Wikoff,  entering  the  surgical  hospital  Sept.  18. 
Examination  shows  a  vigorous  looking  man  with  partial  paral- 
ysis of  left  leg.  There  is  a  scar  on  the  left  side  of  the  back  2i.2 
inches  from  the  median  line  and  on  a  level  with  the  second 
lumbar  vertebra.  This  marks  wound  of  entrance  of  the  ball 
there  is  no  wound  of  exit.  The  patient  says  the  wound  healed 
very  promptly  with  only  slight  discharge  ;  further  that  four 
weeks  elapsed  before  he  could  rest  any  weight  upon  the  leg, 
but  he  has  been  improving  ever  since  and  can  now  walk  with  a 
cane.  There  is  marked  wasting  of  the  extensor  muscles  of  the 
left  thigh  and  marked  impairment  of  sensation  of  the  left  foot 
and  leg.  He  says  that  occasionally  the  leg  gives  way  in  walk- 
ing, especially  if  the  toe  strikes  something  above  the  level  of 
the  ground.  He  can  not  raise  it  when  flexed  and  states  that 
with  much  walking  the  knee  swells.  There  has  been  no  im- 
pairment of  function  of  bowels  or  bladder  and  no  priapism. 

In  this  case  the  ball  probably  passed  transversely  producing 
contusion  of  the  cord  and  bruising  the  roots  of  the  spinal  nerves 
very  near  their  origin  ;  it  is  probably  lodged  where  it  will  do  no 
further  harm.  The  man  says  the  X-ray  was  used  twice  but  the 
result  of  examination  was  not  reported  to  him. 

Case  83.— B.  F.  Frazier,  age  24,  Company  B,  Twenty-fourth 
Infantry,  has  been  in  the  service  eleven  months.  While  in 
action  July  1,  before  Santiago,  he  received  a  wound  of  the 
right  hand,  the  bullet  entering  the  web  between  the  index 
finger  and  thumb,  passing  through  the  ball  of  the  thumb  and 
making  its  exit  at  the  base  of  the  adductors  over  the  anterior 


235 

row  of  carpal  bones.  No  bone  injury.  The  wound  was  packed 
with  gauze.  The  wound  of  exit  healed  in  two  weeks,  the 
wound  of  entrance  has  never  closed  completely  and  has  dis- 
charged from  time  to  time  a  small  quantity  of  serous  pus.  The 
patient  was  admitted  to  the  surgical  ward  July  15.  Examina- 
tion with  the  probe  revealed  the  presence  of  a  small  metallic 
body.  During  the  preparation  of  the  hand  for  operation  a 
small  triangular  fragment  of  metal  was  washed  out  of  the  fis- 
tulous opening.  Under  anesthesia  next  day  the  wound  was 
again  explored  and  the  probe  passed  to  a  point  underneath  the 
scar  of  the  wound  of  exit,  detected  another  piece  of  metal 
which  was  removed  by  incising  the  scar,  when  a  fragment  of 
lead  much  larger  than  the  first  was  extracted.  On  scraping 
out  the  fistulous  tract  with  a  small  sharp  spoon  shreds  of 
gauze  were  removed.  The  bullet  that  inflicted  the  injury 
must  have  been  a  deflected  one,  as  otherwise  no  fragments  of 
lead  would  hsve  been  left  in  the  wound.  The  gauze  undoubt- 
edly belonged  to  the  packing  used  at  the  first-aid  dressing.  The 
wound  was  dressed  in  the  usual  manner ;  no  provision  for 
drainage  was  made,  with  the  expectation  that  it  would  heal 
speedily  by  primary  intention. 

Case  Si,— John  Marks,  age  22,  Troop  D,  Sixth  Cavalry, 
enlisted  five  months  ago.  He  was  wounded  in  the  charge  on 
San  Juan  Hill,  July  1.  The  bullet  cut  the  margin  of  the  upper 
posterior  edge  of  the  right  ear,  entered  the  scalp  one  inch 
above  and  one  and  a  half  inches  behind  the  right  external 
meatus,  and  emerged  from  the  scalp  three  inches  in  a  direct 
line  from  point  of  entrance,  probably  making  a  superficial 
groove  in  the  external  surface  of  the  occipital  bone.  The 
patient  says  he  was  taken  to  Key  West  while  in  an  unconscious 
condition,  in  which  he  remained  two  days.  July  6  he  was 
operated  on,  the  wound  being  laid  bare  by  a  curved  incision 
and  a  small  piece  of  bone  is  said  to  have  been  removed.  The 
wound  healed  in  a  month.  Scars  healthy  and  not  sensitive  to 
pressure.  He  complains  now  of  attacks  of  throbbing  pains  from 
back  of  head  to  eyes,  three  or  four  times  a  week  ;  the  attacks 
last  sometimes  half  an  hour.  He  does  not  complain  of  vertigo 
or  disturbance  of  any  of  the  special  senses.  Whether  the 
symptoms  are  purely  of  a  neurotic  nature  or  whether  they 
depend  on  the  injury  must  be  determined  by  future  observa- 
tion.    Potassic  bromid  was  prescribed. 

From  the  above  report  I  have  excluded  minor  cases  that 
were  treated  as  out-door  patients  or  inmates  of  the  surgical 
ward  not  of  sufficient  interest  to  have  any  material  bearing  on 
the  subject  of  this  paper.  This  communication  has  been 
written  for  the  special  purpose  of  pointing  out  to  the  profes- 
sion, and  more  especially  to  the  military  surgeons,  the  nature 
and  sphere  of  surgical  work  in  field  hospitals  at  the  end  of  a 


286 


war.     This  completes  my  surgical  work  of  this  war,  and   I 
return  to  civil  life  grateful  to  the  authorities  and  my  colleagues 
for  the  kindness  and  many  courtesies  I  have  received  at  their 
hands. 
General  Hospital,  Camp  Wikofif,  Sept.  17,  1898, 


1 


EMPYEMA  IN  CAMP  GEORGE  H.  THOMAS. 


The  short,  decisive  campaign  with  Spain  just  ended 
was  characterized,  from  a  medical  standpoint,  by  the 
smallness  of  the  number  of  those  killed  in  the  field, 
the  prevalence  of  disease  and  the  large  number  of 
deaths  from  this  source.  The  brilliant  victories  on 
land  and  sea  which  forced  Spain  to  sue  for  peace  have 
cost  us  so  far  over  three  thousand  lives — less  than 
three  hundred  from  the  effects  of  bullets  and  over 
two  thousand  nine  hundred  from  disease.  The  num- 
ber of  deaths  from  disease  will  be  increased  materi- 
ally, as  the  different  military  hospitals  at  home  and 
abroad  still  contain  a  large  number  of  our  sick,  many 
of  whom  will  succumb  to  the  diseases  contracted  dur- 
ing the  campaign.  Even  in  case  the  hostilities  are 
not  renewed,  it  is  impossible  to  predict  the  total  loss 
of  life  at  the  present  time,  to  say  nothing  of  the 
thousands  who  will  never  recover  the  health  they 
brought  into  the  service.  The  unusual  amount  of 
sickness  which  prevailed  among  our  troops,  in  our 
home  camps  and  at  the  seat  of  war,  can  be  attributed 
to  various  causes.  The  call  to  arms  came  at  a  time 
of  the  year  when  bronchial  affections,  pneumonia, 
pleuritis  and  rheumatism  are  prevalent.  In  the  State 
camp  of  the  Illinois  troops  cerebro-spinal  meningitis 
made  its  appearance  during  the  first  days  of  their  en- 
campment. Typhoid  fever  had  its  origin  in  our  State 
camps  and  followed  our  army  to  the  National  camps 
and  to  the  seat  of  war  in  Cuba  and  Porto  Rico.  The 
accumulation  of  large  armies  and  the  prolonged  en- 
campments in  localities  which  lacked  a  system  of 
sewerage,  could  not  fail  in  promoting  the  local  spread 
of  infectious  disease.  The  invasion  of  Cuba  occurred 
during  the  rainy  season,  which  had  a  deleterious  effect 


238 

on  the  health  of  the  unacclimated  troops,  rendering 
them  more  susceptible  to  the  effects  of  the  semitrop- 
ical  climate  and  the  prevailing  diseases.  The  trans- 
portation facilities  for  the  unloading  of  the  transports 
were  utterly  defective  in  furnishing  the  invading  army 
at  the  proper  time  with  the  necessary  supplies.  The 
clothing  of  our  troops  was  not  adapted  for  the  Cuban 
climate.  And,  lastly,  the  necessary  precautions  to 
protect  the  troops  against  yellow  fever,  which  is  always 
found  on  the  Cuban  coast,  where  the  landing  was 
effected,  were  not  carried  into  effect.  The  command- 
ing general  had  been  fully  advised  by  the  Chief  Sur- 
geon of  the  Army  in  the  Field,  but  the  instructions 
were  ignored  in  the  haste  and  tumult  of  the  brief 
campaign.  A  lack  of  a  good  knowledge  of  sanitation 
on  the  part  of  many  of  the  medical  officers,  and  espe- 
cially the  inadequate  policing  of  the  camps,  had  their 
influence  in  promoting  the  local  spread  of  disease. 
Amebic  dysentery  and  malaria,  the  two  tropical  dis- 
eases to  which  our  troops  were  exposed  in  the  south- 
ern camps  and  in  Cuba  and  Porto  Eico  figured 
largely  in  the  sick  and  mortality  reports.  The  pre- 
vention of  these  diseases  was  beyond  the  control  of 
the  medical  department.  The  ordinary  camp  diarrhea, 
from  which  almost  every  participant  of  the  war  suf- 
fered to  a  greater  or  lesser  extent,  I  am  satisfied,  did 
much  to  increase  the  receptivity  of  our  soldiers  to 
typhoid  fever  infection. 

Another  matter  of  the  greatest  importance  concern- 
ing the  health  of  our  troops  was  the  regulation  gov- 
ernment ration.  The  food  selected  and  furnished  for 
the  army  in  Cuba  and  Porto  Rico  was  the  same  as 
that  which  had  been  used  in  the  North.  Every  one 
who  served  at  the  front  for  any  length  of  time  must 
be  convinced  that  the  emaciated,  starved  condition  of 
our  soldiers  who  returned  from  Cuba,  and  who  escaped 
disease,  was  largely  due  to  the  nature  of  the  food  upon 
which  they  had  to  subsist.  The  purchase  of  food  at 
the  seat  of  war  was  out  of  question.  Investigation 
will  undoubtedly  prove  that  many  of  the  canned  meats 


239 

did  not  contain  the  amount  of  nutriment  claimed  for 
them.  Fresh  meat  and  black  bread  furnished  the 
continental  armies  are  not  only  more  palatable,  but 
also  more  nutritious  than  the  canned  meats  and  hard- 
tack furnished  our  army.  A  careful  inquiry  into  the 
kind  of  food  our  occupation  armies  should  be  fur- 
nished, is  one  of  the  most  important  duties  of  those 
who  are  in  charge  of  the  commissary  department.  An- 
other subject  of  special  importance  is  the  special  diet 
for  the  sick. 

It  is  to  be  hoped  that  the  medical  department  will 
be  consulted  concerning  these  matters,  and  that  the 
recommendations  made  will  receive  the  well- merited 
attention  of  the  military  authorities.  During  my 
service,  I  met  one  of  our  soldiers  who  served  under 
General  Gordon  in  his  advance  on  Khartoum,  who 
informed  me  that  during  that  campaign  the  British 
troops  were  supplied,  on  the  whole,  with  much  better 
food  than  was  the  case  in  Cuba.  England  has  bene- 
fited by  long  experience  how  to  conduct  a  campaign 
in  a  tropical  climate;  we  are  novices  in  this  kind  of 
warfare,  but  have  learned  enough  during  the  last  six 
months  to  enable  us  to  take  better  care  of  our  troops, 
should  we  again  be  called  upon  to  conduct  a  war 
beyond  the  limits  of  our  country. 

I  have  deemed  it  appropriate  and  advisable,  in 
accepting  your  kind  invitation  to  deliver  the  address 
at  this  annual  meeting,  to  discuss  briefly  and  from 
the  most  practical  standpoint,  a  surgical  affection 
which  I  had  an  opportunity  to  study  in  a  most  satis- 
factory manner  during  my  service  at  Chickamauga. 
It  is  my  purpose  to  occupy  my  allotted  time  by  relat- 
ing my  experience  with  empyema  in  Camp  George 
H.  Thomas.  I  was  on  duty  as  chief  surgeon  in  that 
camp  for  nearly  four  weeks  during  the  months  of  May 
and  June.  During  that  time  the  camp  was  occupied 
by  nearly  40,000  men,  representing  nearly  all  of  the 
States  east  of  the  Rocky  Mountains.  With  the  excep- 
tion of  one  company  of  cavalry  on  guard  duty,  the 
army  was  composed  entirely  of  volunteers.     The  days 


240 


were  hot,  the  nights  cool ;  the  midday  temperature 
frequently  reached  98  to  100  degrees  F.  The  drouth 
which  prevailed  at  that  time  rendered  the  roads  dusty, 
the  clouds  of  dust  being  only  settled  occasionally  by 
showers  of  short  duration.  Camp  diarrhea,  dysen- 
tery, cerebro- spinal  meningitis,  pneumonia  and  ty- 
phoid fever  were  then  the  principal  diseases  we  had 
to  contend  with. 

It  is  one  of  the  complications  of  pneumonia — 
empyema — as  observed  in  Camp  George  H.  Thomas, 
that  I  desire  to  discuss  this  evening.  Empyema  rep- 
resents the  pathologic  product  of  suppurative  pleu- 
ritis.  Suppurative  pleuritis  is  always  the  result  of  a 
pyogenic  infection  of  the  pleura  sufficient  in  virulence 
to  give  rise  to  pus  formation.  In  the  absence  of 
traumatic  causes  it  appears  clinically  and  patholog- 
ically either  as  an  isolated  inflammation  of  the  pleura 
or  as  a  more  or  less  remote  complication  of  pneu- 
monia. Bacteriologically  speaking,  suppurative  pleu- 
ritis can  only  result  from  the  presence  in  and  the 
specific  action  upon,  the  tissues  of  the  pleura  of  pyo- 
genic microbes  in  sufficient  number  and  virulence  to 
give  rise  to  a  suppurative  inflammation. 

Non- traumatic,  suppurative  pleuritis  is  a  compara- 
tively rare,  isolated  affection;  in  the  great  majority  of 
cases  it  presents  itself  as  a  complication  of  pneu- 
monia. Recent  investigations  tend  to  prove  that  the 
essential  cause  of  pneumonia  is  either  Frankel's  pneu- 
mococcus,  Friedlander's  bacillus  of  pneumonia  (dip- 
plo-bacillus)  or  the  streptococcus  pyogenes.  Strep- 
tococcus pneumonia,  occurring  either  as  a  primary  or 
secondary  affection,  is  characterized  clinically  by  the 
gravity  of  the  disease  and  pathologically  by  the 
tendency  to  pus  formation.  The  microbes  of  pneu- 
monia discovered  and  described  by  Frankel  and 
Friedlander  are  the  bacteriologic  agents  usually 
found  in  the  inflamed  tissues  in  croupous  pneumonia. 
Both  these  microbes  possess  feeble  intrinsic  pyogenic 
properties,  and  when,  during  the  pneumonic  process, 
abscess  formation  or  suppurative  pleuritis  sets  in,  the 


241 


complication  occurs  usually  as  the  result  of  a  second- 
ary or  Eoixed  infection  with  pus  microbes.  Croupous 
pneumonia  is  a  self-limited  disease,  and  when  febrile 
symptoms  persist  after  a  sufficient  time  has  elapsed 
for  the  disease  to  complete  its  typic  cycle,  it  is  usually 
an  indication  that  mixed  infection  has  occurred,  and 
in  this  event  it  becomes  the  urgent  duty  of  the 
attending  physician  to  look  for,  locate  and  determine, 
if  possible,  the  nature  of  the  complication  to  enable 
him  to  institute  timely,  appropriate  therapeutic 
measures. 

In  suppurative  pleuritis  complicating  pneumonia, 
the  inflamed  lung  tissue  is  seldom  involved  in  the 
suppurative  process.  Resolution  may  proceed  in  a 
satisfactory  manner  at  the  time  and  after  the  suppu- 
rative pleuritis  has  set  in,  a  fact  which  would  tend  to 
prove  that  the  parenchyma  of  the  lung  is  more  resist- 
ant to  the  action  of  pyogenic  microbes  than  the 
tissues  of  the  pleura,  or  that  these  microbes  find  their 
way  more  readily  to  the  pleura  than  into  the  pneu- 
monic focus  after  secondary  infection  has  occurred. 
The  complicating  secondary  pleuritis  manifests  itself 
usually  about  the  time  the  crisis  is  expected  or  a  few 
days  later.  It  is  evident  that  suppurative  complica- 
tions in  cases  of  pneumonia  would  be  likely  to  appear 
in  cases  in  which  the  tissues  are  rendered  suscepti- 
ble to  the  action  of  pus  microbes  and  under  circum- 
stances which  would  supply  the  bacteria  for  the  sec- 
ondary, mixed  infection. 

Both  these  conditions  were  present  and  operative 
in  Camp  George  H.  Thomas.  The  health  of  many  of 
the  men  encamped  at  Chickamauga  was  impaired 
soon  after  reaching  camp  by  the  sudden  climatic 
changes,  change  of  food,  malaria  and  camp  diarrhea. 
Nearly  all  cases  of  pneumonia  were  characterized  by 
the  gravity  of  the  symptoms  and  a  tardiness  with 
which  resolution  occurred.  Camp  Thomas  was 
located  on  the  government  reservation  ten  miles 
south  of  Chattanooga.  The  ground  is  undulating  and 
in  part  well  wooded.     Numerous  clearings  and  open 


242 

spaces  furnished  excellent  facilities  for  the  drilling 
and  maneuvering  of  the  troops.  The  National  Park 
is  traversed  by  a  sluggish  stream,  the  Chickamauga. 
Three  regiments  of  cavalry  and  a  number  of  batteries 
were  in  camp  during  the  month  of  June,  the  time 
the  five  cases  of  pneumonia  complicated  by  empyema 
came  under  my  observation.  The  ground  is  inter- 
sected by  numerous  roads  which  during  the  season  of 
drouth  which  prevailed  at  that  time,  became  covered 
with  inches  of  fine  dust,  which  by  driving  of  innu- 
merable vehicles  of  all  kinds,  the  marching  of  troops, 
the  passage  of  cavalry  and  artillery  would  rise  in 
dense  clouds  and  by  sudden  gusts  of  wind  would  often 
cover  the  entire  camp.  This  dust  was  contaminated 
by  pathogenic  microbes  of  all  kinds,  which  could  not 
fail  in  finding  their  way  into  the  air-passages  of  the 
occupants  of  the  camp.  The  dust  was  most  abundant 
near  the  roads  on  which  there  was  the  most  travel, 
that  is,  near  headquarters. 

It  was  not  strange  that  most  of  the  cases  of  pneu- 
monia originated  in  localities  where  the  dust  clouds 
were  densest,  filling  the  tents  and  kitchens  and  cov- 
ering the  food  supplies.  The  dust  had  undoubtedly 
some  influence  in  the  causation  of  pneumonia,  and 
more  particularly  in  determining  the  frequency  with 
which  it  was  attended  or  followed  by  suppurative 
pleuritis. 

Many  of  the  soldiers  left  their  State  camps  affected 
by  bronchial  catarrh,  which  constituted  a  potent  iDre- 
disposing  cause  to  pneumonia.  This  was  particularly 
true  of  some  of  the  regiments  from  Illinois.  Natu- 
rally the  first  regiments  arriving  at  Camp  Thomas 
were  quartered  near  the  great  thoroughfares  of  travel 
and  those  arriving  later  in  more  remote  parts  of  the 
camp.  It  is  a  noteworthy  fact  that  those  regiments 
farthest  away  from  headquarters  were  almost  free 
from  pneumonia,  while  those  nearest  the  center  of 
travel  furnished  the  largest  number  of  cases.  The 
cool  nights,  the  lying  on  the  moist  ground  and  the 
inadequate  sui^ply  of  blankets  did  their  share  in  serv- 


243 

ing  as  potent  exciting  causes.  Some  definite  infor- 
mation in  reference  to  the  distribution  of  the  disease 
can  be  gained  by  considering  the  location  of  the  divi- 
sion hospitals,  and  the  number  of  cases  of  pneumonia 
treated  in  each  one  of  them.  The  division  hospitals 
were  located  as  near  the  center  of  the  respective  divi- 
sions as  possible. 

The  First  Division  Hospital  was  established  on  the 
Lafayette  Road,  about  three-quarters  of  a  mile  from 
the  headquarters  of  the  corps.  The  Second  Division 
Hospital  was  established  about  two  miles  from  head- 
quarters and  about  one-quarter  of  a  mile  from  any 
principal  thoroughfare,  the  Brotherton  Road  being 
the  nearest  one.  But  few  of  the  regiments  of  this 
division  were  encamped  on  roads  subject  to  much 
travel. 

The  Third  Division  Hospital  was  located  at  the 
junction  of  the  Alexander's  Bridge  Road  and  the  Jay's 
Mills  Road,  about  two  miles  from  headquarters.  Some 
of  the  regiments  of  this  division  were  quartered  on 
roads  which  were  used  by  the  wagon  trains  hauling 
water,  consequently  frequently  exposed  to  clouds  of 
dust. 

During  the  latter  part  of  May  and  the  month  of 
June  forty- six  cases  of  pneumonia  developed  in  the 
First  Army  Corps.  These  cases  were  distributed 
among  the  division  hospitals  as  follows:  Hospital  at 
Headquarters,  4  cases;  First  Division  Hospital,  32 
cases;  Third  Division  Hospital,  10  cases.  The  Second 
Division  Hospital  was  not  established  until  the  mid- 
dle of  June,  and  from  that  time  on  until  the  end  of 
the  month  not  a  single  case  of  pneumonia  was 
reported.  Careful  inquiry  at  the  regimental  hospi- 
tals failed  in  finding  a  case  previous  to  the  establish- 
ment of  the  division  hospital.  This  was  the  division 
encamped  almost  entirely  away  from  any  of  the  prin- 
cipal roads,  hence  least  subjected  to  dust-infection. 
It  will  be  noticed  that  32  cases,  or  nearly  70  per  cent, 
of  the  entire  number,  occurred  in  the  First  Division 
regiments.     Out  of  these  forty-six  cases  six  died,  or  a 


244 

mortality  of  13  per  cent.  The  six  fatal  cases  came 
from  the  First  Division.  In  three  of  these  fatal  cases 
death  was  caused  by  the  progressive  extension  of  the 
septic  pneumonia,  and  in  the  remaining  three  death 
was  caused  by  complications.  In  one  case  death  was 
attributed  to  a  typhoid  condition;  in  two  to  cerebro- 
spinal meningitis.  The  septic  nature  of  the  cases  of 
pneumonia  which  developed  in  the  First  Division  is 
best  shown  by  the  frequency  with  which  empyema 
attended  or  followed  the  pulmonary  disease.  In  this 
division  empyema  complicated  the  pneumonia  in  nine 
out  of  the  entire  number  of  thirty-two  cases,  equal  to 
28  per  cent.  Four  of  these  cases  were  treated  at  the 
Leiter  Hospital  and  four  at  the  St.  Vincent's  Hospi- 
tal, Chattanooga.  Five  of  these  cases  were  operated 
upon  by  myself:  four  at  the  St.  Vincent's  Hospital 
and  one  at  the  Leiter  Hospital.  The  following  case 
represents  the  pathologic  conditions  found  in  these 
cases  as  well  as  the  surgical  treatment  which  was 
resorted  to  in  meeting  the  indications  of  the  empy- 
emic  complication : 

W.  F.,  private,  Third  Ills.  Vols.,  was  taken  suddenly  ill 
while  on  drill,  May  30.  The  attack  was  initiated  by  nausea, 
vomiting,  dizziness  and  a  sense  of  great  prostration.  On  the 
following  day  severe  diarrhea  set  in,  which,  in  connection  with 
persistent  vomiting  and  intense  headache,  influenced  his  phy- 
sician to  transfer  him  to  the  division  hospital.  At  that  time 
physical  examination  revealed  a  well-marked  bronchitis.  In 
the  evening  he  had  a  decided  chill ;  temperature  103. 

June  1  he  complained  of  severe  pains  in  his  chest  and  back, 
cough  dry  and  hacking,  sputum  tinged  a  rusty  color.  Diar- 
rhea continues  ;  slight  delirium  ;  temperature  99  in  the  morn- 
ing, 103  in  the  evening. 

June  2.  Chest  pains  not  relieved,  sputum  more  deeply 
tinged.     Temperature  varies  from  101.5  to  103. 

June  3.  Diarrhea  under  control ;  cough  and  expectoration 
unchanged  ;  delirium  and  temperature  about  the  same. 

June  4.  No  material  change  in  the  condition  of  the  patient ; 
tongue  dry  and  dark  brown. 

Daily  examinations  of  the  chest  did  not  reveal  any  signs  of 
consolidation  of  the  lung  until  June  6.  At  this  time  the  mid- 
dle and  a  part  of  the  upper  lobe  of  the  right  lung  were  found 
consolidated.     Temperature  102. 

June  7.     Patient  delirious  most  of  the  time  ;  cough  narass- 


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246 

ing,  and  copious  expectoration  of  rusty  sputum.  Temperature 
rose  rather  suddenly  to  105, 

June  8.  Cough  less  troublesome,  sputum  more  scanty  ;  sub- 
jective symptoms  improved.  Patient  was  transferred  to  the 
Leiter  General  Hospital,  when  on  his  arrival  the  temperature 
was  found  to  be  102.4.  The  medication  at  this  time  consisted 
of  strychnia  in  small  doses,  muriate  of  ammonia  5  grains  every 
four  hours,  alternated  with  3  drops  of  turpentine.  Under  this 
treatment  the  temperature  was  reduced  Ifo  degrees  during  the 
first  day,  2  degrees  the  second,  and  l^.y  degrees  the  third  day, 
becoming  normal  June  11.  Carbonate  of  ammonia  was  sub- 
stituted for  the  muriate  at  this  time. 

From  June  12  to  18  the  temperature  ranged  one  degree  above 
and  below  normal.  The  pulse,  which  had  been  118  beats  per 
minute  and  feeble  on  his  admission  to  the  Leiter  Hospital, 
became  fuller  and  stronger  and  diminished  in  frequency  to  80. 

June  19.  Temperature  suddenly  rose  in  the  afternoon  to 
102,  pulse  96. 

June  20.  Examination  of  chest  showed  absolute  dulness  on 
the  right  side,  extending  as  high  as  the  fourth  rib.  The 
appearance  of  fever  after  a  few  days  of  complete  defervescence 
and  the  rapid  increase  of  the  area  of  dulness,  displacement 
of  the  apex- beat  to  the  right,  as  well  as  a  marked  bulging  of 
the  lower  intercostal  spaces,  left  no  doubt  of  the  existence 
of  empyema.  The  symptoms  indicating  the  presence  of 
this  complication  were  so  evident  that  it  was  not  deemed 
necessary  to  resort  to  an  exploratory  puncture  to  verify  the 
diagnosis. 

In  all  of  the  cases  of  pneumonia  complicated  by 
empyema  that  came  under  my  personal  observation, 
the  disease  pursued  a  very  similar  course  to  the  one 
described.  The  clinical  symptoms  were  characterized 
by  their  severity.  The  patient's  general  condition 
left  little  doubt  as  to  the  septic  nature  of  the  original 
disease.  As  in  the  case  detailed,  the  suppurative 
pleuritis  commenced  two  to  thre"e  days  after  the  pneu- 
monic symptoms  had  subsided,  its  onset  being 
announced  by  a  rise  of  temperature  and  the  appear- 
ance of  local  and  general  symptoms,  suggestive  of  the 
existence  of  a  suppurative  affection. 

It  is  more  than  probable  that  in  most  of  these  cases 
the  pyogenic  microbes,  which  eventually  attacked  the 
pleura  and  caused  the  suppurative  process,  entered 
the  lungs  at  the  same  time  and  in  the  same  manner 
as  the  microbes  which  caused  the  pneumonia.     The 


1 

1 


247 

bronchitis  and  diarrhea  which  initiated  the  disease 
were  plain  evidences  pointing  in  this  direction.  In 
some  of  the  cases  in  which  the  pneumonia  pursued  a 
more  typic  course,  the  subsequent  suppurative  pleu- 
ritis  was  caused  by  a  secondary  mixed  infection.  All 
cases  of  empyema  which  were  subjected  to  operative 
treatment  were  characterized  pathologically  by  the 
presence  of  an  abundant  fibrinous  exudate,  which 
covered  both  the  visceral  and  parietal  pleurie,  and,  in 
the  form  of  large  fibrinous  masses,  mixed  with  the 
thick  cream-like  pus.  The  purulent  accumulation 
occurred  rapidly,  filling  the  pleural  cavity  in  a  very 
few  days.  Displacement  of  the  heart,  enlargement  of 
the  chest  and  bulging  of  the  intercostal  spaces  were 
the  most  significant  local  signs  indicating  the  pres- 
ence of  a  large  quantity  of  pus  in  the  cavity  of  the 
chest.  The  right  and  the  left  sides  were  afPected  with 
about  the  same  frequency.  In  one  case  the  pleuritis 
was  limited,  leading  to  a  circumscribed  empyema  in 
the  left  side.  The  abscess  occupied  the  lower  and 
posterior  part  of  the  chest.  In  performing  the  rad- 
ical operation  in  this  case,  a  section  of  the  tenth  rib, 
about  three  inches  from  the  spinal  end,  had  to  be 
excised.  The  location  of  the  empyema  was  deter- 
mined beforehand  by  systematic  exploratory  punc- 
tures, the  first  two  punctures  yielding  negative  evi- 
dence. As  a  rule,  expansion  of  the  compressed  lung 
followed  soon  after  the  operation,  showing  that  reso- 
lution had  occurred  before  or  after  the  pleuritic  com- 
plication appeared. 

In  some  of  the  cases  suppuration  was  scanty  after 
the  operation;  in  others  it  was  abundant.  In  the 
former  event  a  process  of  repair  set  in  promptly ;  in 
the  latter  case  it  was  retarded.  The  final  process  of 
obliteration  of  the  pleural  cavity  was  accomplished  by 
granulation,  cicatrization  and  cicatricial  contraction. 
Evacuation  of  the  pus  and  drainage  were  always  fol- 
lowed by  a  fall  in  the  temperature  to  normal,  or 
nearly  so,  accompanied  by  symptoms  denoting  rapid 
improvement  of  the  patient's  general  condition.     In 


248 

two  of  the  cases  the  physicians  in  attendance  were 
misled  in  their  diagnosis  by  the  absence  of  fever. 
The  pleuritis  was  initiated  as  usual  by  a  rise  in  tempera- 
ture and  other  febrile  disturbances,  which  subsided  in 
a  few  days,  the  patients  feeling  well  with  the  excep- 
tion of  the  complaint  of  embarrassment  of  the  respi- 
ration. In  one  case  the  respiration  was  so  much 
interfered  with  by  the  copious  pleuritic  exudate  that 
the  lips  were  blue  and  the  pulse  almost  imperceptible 
— conditions  which  necessitated  the  performance  of 
the  operation  without  an  anesthetic.  We  relied  in 
this  case  on  strychnia  and  whiskey  to  counteract  the 
immediate  effects  of  the  operation.  In  the  absence 
of  such  contraindications  ether  was  used  as  an  anes- 
thetic, aided  by  the  administration  of  some  heart 
stimulants  immediately  before  the  administration  of 
the  anesthetic. 

OPERATION  FOR  EMPYEMA. 

The  existence  of  an  empyema  in  the  adult  is  a  suffi- 
cient indication  for  the  performance  of  a  radical  ope- 
ration. Puncture  and  removal  of  the  pus  by  aspira- 
tion may  succeed  occasionally  in  mild  cases  of  sup- 
purative pleuritis  in  the  case  of  children;  seldom,  if 
ever  in  the  adult.  Operative  treatment  should  be 
instituted  as  soon  as  a  diagnosis  can  be  made.  Unless 
the  signs  and  symptoms  are  conclusive,  the  diagnosis 
should  be  verified  and  the  pus  accurately  located  by 
an  exploratory  puncture,  as  was  done  in  most  of  the 
oases  operated  upon  in  Camp  Thomas.  Nothing  is 
gained  and  much  is  lost  by  postponing  surgical  treat- 
ment until  the  accumulated  pus  has  increased  to  the 
extent  of  producing  serious  and  often  irremediable 
compression  of  the  lung  on  the  affected  side.  The 
plastic  exudate,  which  is  often  copious,  as  in  all  the 
cases  forming  the  basis  for  this  address,  is  another 
source  of  danger  in  case  the  operation  is  not  promptly 
performed,  as  it  creates  conditions  unfavorable  to  the 
subsequent  expansion  of  the  compressed  lung  and 
extenuates  indefinitely  the  infection. 


249 

In  view  of  the  pathologic  anatomy  presented  by 
the  cases  of  empyema  which  constitute  the  basis  for 
this  paper,  it  must  be  admitted  that  the  only  rational 
treatment  consists  in  opening  the  pleural  cavity  freely 
and  in  establishing  efficient  tubular  drainage.  Inter- 
costal incision  and  drainage  do  not  enable  the  sur- 
geon to  remove  the  large  fibrinous  masses  which  play 
such  an  important  role  in  maintaining  suppuration 
and  in  preventing  speedy  obliteration  of  the  pleural 
cavity.  The  fibrinous  exudate  contains  pus  microbes, 
and  unless  removed  at  the  time  the  operation  is  per- 
formed, serves  as  a  nutrient  medium  for  their  growth 
and  reproduction  and  interferes  mechanically  with 
pulmonary  expansion  and  speedy  obliteration  of  the 
pleural  cavity  by  granulation  and  cicatrization.  One 
of  the  important  modern  indications  in  the  surgical 
treatment  of  empyema  is  to  remove  the  inflammatory 
product  as  thoroughly  as  possible,  and  this  can  only 
be  done  after  opening  the  cavity  sufficiently  to  remove 
by  mechanic  measures  the  infected  exudate.  In 
recent  cases  resection  of  two  inches  of  one  rib  at  a 
point  where  drainage  will  be  most  effectual  will  afford 
sufficient  room  to  subject  the  pleural  cavity  to  a  thor- 
ough removal  of  the  inflammatory  exudate.  With 
the  exception  of  the  case  of  circumscribed  empyema, 
we  opened  the  chest  in  the  axillary  line  where  the 
ribs  are  nearest  the  skin  and  usually  resected  the 
seventh  rib.  With  one  exception,  aspiration  was  per- 
formed a  day  or  two  before  the  operation  for  the  pur- 
pose of  securing  partial  pulmonary  expansion  before 
admitting  air  into  the  pleural  cavity. 

Preliminary  aspiration  is  of  special  value  in  the 
treatment  of  large  empyemic  cavities.  The  surface 
of  the  entire  chest  was  thoroughly  disinfected  and 
every  care  taken  to  carry  out  full  aseptic  precautions 
during  the  operation.  The  opening  of  large  pus 
cavities  is  attended  by  great  responsibility,  and  this  is 
more  especially  true  in  empyema,  as  secondary  infec- 
tion is  liable  to  occur  unless  the  operation  is  per- 
formed  under   strictest   aseptic   precautions.     If   an 


250 

anesthetic  is  given,  the  greatest  watchfulness  is  re- 
quired to  guard  against  accidents.  I  always  prefer 
to  perform  the  operation  under  partial  anesthesia,  and 
I  am  very  partial  to  strychnia  and  alcohol  as  valuable 
adjuncts  in  minimizing  its  immediate  and  remote 
dangers. 

I  place  the  patient  partially  on  the  opposite  side 
with  the  chest  slightly  raised,  and  the  arm  on  the  side 
to  be  operated  upon  raised  to  the  side  of  the  head  for 
the  purpose  of  increasing  the  width  of  the  intercostal 
spaces.  I  expose  the  rib  to  be  resected  by  a  slightly 
curved  incision  with  the  convexity  directed  downward, 
beginning  the  incision  at  a  point  corresponding  with 
the  upper  border  of  the  rib,  carrying  it  in  a  gentle 
curve  to  the  lower  border,  and  terminating  it  at  the 
upper  border  at  a  point  about  four  inches  from  where 
it  started.  By  reflecting  the  cutaneous  shallow,  oval 
flap  in  an  upward  direction,  the  muscular  covering  of 
the  rib  is  exposed.  A  straight  incision  over  the  cen- 
ter of  the  rib,  about  three  inches  in  length,  is  then 
made  down  to  the  bone.  With  an  elevator  the  peri- 
osteal envelope  with  the  tissues  attached  to  it  is  then 
separated,  taking  care  to  lift  out  from  its  groove  the 
intercostal  artery  with  the  tissues  to  be  reflected. 
After  laying  bare  the  rib  to  the  extent  of  at  least  two 
inches,  the  rib  is  lifted  forward  with  the  elevator  and 
excised  with  a  strong  pair  of  bone- cutting  forceps.  If 
the  diagnosis  is  positive,  all  that  remains  is  to  make 
an  incision  with  the  scalpel  in  the  center  of  the  peri- 
osteal trough,  large  enough  to  admit  the  tip  of  the 
index  finger. 

The  evacuation  of  the  chest  contents  should  always 
be  done  slowly  ;  this  can  be  done  most  eflPectually  by 
interrupting  the  flow  of  pus  from  time  to  time  by  in- 
serting the  index  finger  into  the  pleural  incision.  After 
evacuation  of  the  pus  and  loose  shreds  of  fibrinous 
material,  the  pleural  cavity  should  be  carefully  exam- 
ined by  direct  inspection  and  digital  exploration. 
Plastic  exudates  attached  to  either  pleura  must  be 
removed  as  thoroughly  as  can  be  done  with  finger  and 


251 

a  small  gauze  sponge  held  securely  in  the  jaws  of  a 
pair  of  long,  preferably  slightly  curved,  forceps.  The 
membranes  should  be  removed  by  mopping  and  not 
by  the  use  of  sharp  instruments.  Scraping  of  the 
pleurae  with  a  sharp  spoon  is  superfluous  and  occa- 
sionally detrimental.  In  acute  cases  I  have  often 
noticed  quite  free  hemorrhage  from  the  pleural  sur- 
faces even  after  gentle  efforts  to  dislodge  the  adherent 
fibrinous  exudate.  Should  troublesome  hemorrhage 
follow  the  procedure,  packing  of  the  pleural  cavity 
with  one  long  strip  of  plain  sterile  gauze  should  at 
once  be  resorted  to.  The  space  below  the  drainage 
opening  is  packed  first,  and  if  the  hemorrhage  is  not 
arrested,  the  balance  of  the  cavity  is  packed  from 
above  downward. 

Tubular  drainage  is  the  ideal  method  of  draining  a 
suppurating  pleural  cavity.  I  use  for  this  purpose 
two  fenestrated  tubular  drains,  the  size  of  the  little 
finger,  about  four  inches  in  length  and  securely  fas- 
tend  together  with  a  large  safety-pin.  Drains  have 
been  repeatedly  lost  in  the  pleural  cavity  for  want  of 
resorting  to  this  simple  precaution.  After  inserting 
the  tubular  drain,  the  external  wound  is  sutured  in 
the  usual  manner.  The  curved  incision,  as  described 
above,  not  only  exposes  the  ribs  more  freely  than  the 
straight  incision,  as  usually  practiced,  but  it  is  also 
much  better  adapted  for  prolonged  drainage. 

I  never  irrigate  the  pleural  cavity  the  day  the  oper- 
ation is  performed.  I  do  so  later,  provided  suppura- 
tion continues.  In  case  irrigation  of  the  pleural  cavity 
becomes  necessary,  care  is  necessary  in  the  selection  of 
the  antiseptic  solution ;  carbolic  acid  and  corrosive  sub- 
limate in  the  usual  strength  are  dangerous,  and  should 
never  be  used.  I  make  use  of  either  a  saturated  solution 
of  the  acetate  of  aluminium  or  Thiersch's  solution. 
Both  of  these  solutions  are  efficient  as  an  antiseptic  and 
non- toxic  even  when  used  in  large  quantities.  The  value 
of  the  double  drain  is  made  apparent  when  it  becomes 
necessary  to  irrigate  the  pleural  cavity.  By  placing 
the  patient  on  the  opposite  side,  the  fluid  which  enters 


252 

the  chest  through  one  tube  escapes  through  the  other' 
as  soon  as  the  cavity  is  full,  thus  washing  it  out  thor- 
oughly. By  placing  the  patient  on  the  affected  side 
the  cavity  is  emptied,  when  the  same  procedure  is 
repeated  until  the  solution  returns  clear.  The  solu- 
tion used  should  always  be  heated  to  blood  tempera- 
ture, as  irrigation  with  a  cold  solution  is  fraught  with 
danger. 

The  external  dressing  should  consist  of  a  thick 
cushion  of  sterile  gauze  and  absorbent  cotton  to 
absorb  the  fluid  as  fast  as  it  escapes,  and  to  provide 
the  wound  with  a  filter  to  prevent  post-operative  in- 
fection. The  best  way  of  keeping  the  dressing  in 
place  and  to  prevent  the  entrance  of  unfiltered  air 
into  the  cavity,  is  to  substitute  for  the  ordinary  band- 
age the  rubber  webbing  bandage.  Change  of  dressing 
and  antiseptic  irrigation  become  necessary  as  often  as 
the  dressing  becomes  saturated.  For  the  purpose  of 
obviating  frequent  changes,  the  dressings  should  be 
ample. 

As  the  cavity  diminishes  in  size  the  drains  are 
shortened  from  time  to  time,  and  sooner  or  later  one 
of  them  can  be  dispensed  with.  Premature  removal 
of  the  drain  is  often  followed  by  relapse.  Drainage 
must  not  be  suspended  until  the  surgeon  can  satisfy 
himself  by  careful  examination  that  the  pleural  cavity 
has  become  obliterated. 

Should  the  lung  fail  to  expand  sufficiently  in  the 
course  of  a  few  months  to  place  the  cavity  in  a  condi- 
tion for  definitive  healing,  Schede's  thoracoplastic 
operation  is  the  operation  of  choice,  as  Estlander's 
multiple  rib  resection  has  not  yielded  the  expected 
results  in  the  practice  of  many  operators,  including 
my  own.  It  is  well  for  the  surgeon  to  keep  close 
watch  of  the  size  of  the  cavity  during  the  after-treat- 
ment. It  has  always  been  my  custom,  at  stated  inter- 
vals, to  place  the  patient  on  the  opposite  side,  then 
fill  the  cavity  with  one  of  the  antiseptic  solutions  used 
for  irrigation,  then  evacuating  the  chest  by  reversing 
the  position  and  measure  the  quantity  of  fluid  re- 


253 

moved.  By  recording  the  results  of  such  measure- 
ments, we  are  in  a  position  to  judge  with  mathematic 
precision  the  size  of  the  cavity,  and  determine  whether 
or  not  healing  is  possible  without  further  and  more 
serious  operative  interference.  Prompt  and  progres- 
sive improvement  followed  the  operation  in  all  of  mj' 
cases  of  empyema  operated  upon  in  Camp  Thomas. 
In  most  of  the  cases  suppuration  was  soon  under  con- 
trol, followed  by  speedy  pulmonary  expansion  and 
permanent  healing  of  the  empyemic  cavity  by  granu- 
lation. In  two  of  the  cases  a  recent  examination 
made  by  Dr.  A.  F.  Lemke  showed  that  the  patients 
recovered  their  former  health. 

Our  limited  means  of  making  a  satisfactory  bacte- 
riologic  examination  of  the  inflammatory  product 
made  it  impossible  to  ascertain  in  each  case  the  nature 
of  the  microbic  cause  of  the  suppurative  complica- 
tion. In  two  of  the  cases,  inoculation  of  proper 
nutrient  media  resulted  in  an  abundant  growth  of  the 
staphylococcus  pyogenes  aureus.  I  have  but  little 
doubt  that  in  most,  if  not  in  all  cases,  the  suppura- 
tive pleuritis  developed  in  consequence  of  a  secondary 
infection  with  pus  microbes,  probably  in  most  instan- 
ces with  the  staphylococcus,  as  indicated  by  the  clin- 
ical course  of  the  disease  and  the  nature  of  the 
inflammatory  product.  The  etiologic  relationship  of 
dust  to  pneumonia,  and  especially  the  pleuritic  com- 
plication, must  be  regarded  as  established  by  the  facts 
related  above. 

The  influence  of  dust  in  the  causation  of  pneumo- 
nia and  suppurative  pleuritis  acts  in  two  ways  in  the 
causation  of  these  diseases:  1.  The  mechanical  irri- 
tation of  the  bronchial  mucous  membrane  resulting 
from  the  presence  of  ordinary  dust  renders  the  epi- 
thelial layer  of  the  bronchial  mucous  membrane  more 
permeable  to  the  entrance  of  pathogenic  microbes. 
2.  Pathogenic  microbes,  and  in  this  case  pus  microbes, 
are  suspended  in  the  dust  and  find  with  it  entrance 
into  the  air-passages. 

The   importance  of   early  radical  operative  inter- 


254 

vention  in  the  treatment  of  empyema  can  not  be 
overestimated.  The  only  efficient  treatment  in  such 
cases  consists  in  opening  the  cavity  of  the  chest  freely 
by  rib  resection,  removal  of  inflammatory  product  and 
establishing  free  tubular  drainage,  followed  by  safe  and 
efficient  irrigation,  should  subsequent  suppuration 
demand  it. 


ESCULAPIUS  ON   THE  FIELD   OF  BATTLE. 


Esculapius  on  the  field  of  battle  !  What  an  inspir- 
ing sentiment  at  this  time  and  on  this  occasion!  Escu- 
lapius, the  fabled  deity  of  medicine,  engaged  on  the 
battlefield  in  directing  his  faithful  disciples  in  bring- 
ing comfort  to  the  dying  and  timely  and  efficient  aid  to 
the  wounded,  is  indeed  an  idea  conveying  the  loftiest, 
noblest,  soul- inspiring  subject.  The  disciples  of  Escu- 
lapius have  followed  and  served  every  army  since  man 
has  resorted  to  contest  by  force  of  arms  to  secure  the 
real  or  imaginary  rights  of  tribes  and  nations.  Every 
battlefield  bears  testimony  of  their  life-saving,  human- 
itarian work.  When  battles  were  fought  hand-to  hand, 
and  by  the  use  of  the  most  primitive  weapons  of  war, 
the  Esculapians  were  there  with  their  pots  of  boiling 
oil  with  which  to  stanch  bleeding,  with  their  crude 
instruments  with  which  to  extract  arrows  buried  in 
the  flesh  of  the  wounded  warriors,  and  with  their 
bottles  of  wine  and  oil  with  which  to  dress  the  wounds. 
Their  practice  has  kept  more  than  pace  with  the  rapid 
and  wonderful  improvements  in  the  implements  of 
destruction  employed  on  the  battlefield. 

It  is  a  long  time  since  civilized  nations  abandoned 
the  catapult  for  the  cannon,  and  the  small-caliber, 
repeating  breech-loader  has  taken  the  place  of  the 
bow  and  arrow,  but  the  disciples  of  Esculapius  have 
more  than  counterbalanced  the  increased  horrors  of 
war  by  the  marvelous  advancements  made  in  the  sci- 
ence and  art  of  surgery.  The  battlefield  has  witnessed 
many  changes  in  the  practice  of  military  surgeons. 
It  was  on  the  battlefield  that  Ambroise  Par6  substi- 
tuted the  ligature  for  the  cautery  in  arresting  hemor- 
rhage. It  was  on  the  battlefield  that  Hans  Ryf,  Baron 
Larrey,  PirogoflP,  Guthrie,   Nussbaum,  Langenbeck, 


256 

Esmarch,  Stromeyer,  Billroth,  and  a  host  of  other 
worthy  priests  in  the  temple  of  Esculapius,  achieved 
lasting  fame. 

Conservative  surgery  is  the  pride  of  the  modern 
Esculapian  on  the  field  of  battle.  The  stacks  of 
amputated  limbs  that  constituted  such  a  gruesome 
and  constant  sight  after  every  great  battle  during  the 
Civil  War,  will  never  be  seen  again  on  the  field  of 
battle  where  modern  surgery  is  practiced.  Aseptic 
surgery  has  driven  out  of  our  military  hospitals  the 
four  greatest  enemies  of  the  wounded  soldier:  hospi- 
tal gangrene,  secondary  hemorrhage,  pyemia  and  ery- 
sipelas. The  probe,  an  instrument  of  torture,  danger 
and  fallacy,  has  been  abandoned  for  the  X-ray  in 
locating  bullets  lodged  in  the  body.  The  first-aid 
dressing  properly  applied  at  the  right  time  constitutes, 
in  the  vast  majority  of  cases,  almost  a  sure  protection 
against  infection  of  the  wound.  Under  aseptic  pre- 
cautions penetrating  gunshot  wounds  of  the  large 
joints  heal  promptly,  often  without  serious  impair- 
ment of  the  function  of  the  joint.  Many  cases  of 
penetrating  wounds  of  the  chest  and  abdomen  re- 
cover without  operative  interference.  Prophylaxis  has 
largely  taken  the  place  of  operative  surgery  in  the 
field.  Our  recent  experience  in  Cuba  and  Porto  Eico 
has  demonstrated  that  the  small-caliber  rifle  is  a  most 
humane  weapon.  If  the  wounded  survive  the  imme- 
diate efPects  of  the  injury  the  prospects  of  recovery 
are  good.  Most  of  the  wounds  of  the  soft  parts  out- 
side the  three  large  cavities  healed,  with  few  excep- 
tions, under  one  dressing  in  from  ten  days  to  three 
weeks.  What  a  contrast  with  the  experience  of  the 
surgeons  during  the  Civil  War  only  thirty-five  years 
ago!  This  wonderful  improvement  in  military  sur- 
gery has  been  brought  about  through  the  labors  of 
the  disciples  of  Esculapius  during  the  last  thirty 
years. 

Esculapius  is  unselfish  and  impartial  in  his  work. 
His  deeds  of  mercy  are  dispensed  alike  to  friend  and 
foe.     He  knows  no  creed,  no  politics.     He  is  on  the 


257 

side  of  wrong  as  well  as  justice.  He  is  loyal  to  every 
flag  hoisted  on  the  field  of  battle.  He  rejoices  with 
the  victorious,  he  sympathizes  with  the  vanquished. 
He  loves  and  respects  the  uniform  of  every  nation. 
He  is  not  anxious  for  war,  but  when  war  does  come 
he  is  promptly  on  the  field  and  remains  there  as  long 
as  a  single  soldier  requires  his  services.  He  never 
sleeps.  His  thoughts,  his  actions,  are  devoted  to  the 
welfare  and  usefulness  of  the  soldier.  He  is  the 
adviser  of  the  well,  the  comforter  and  physician  of 
the  sick  and  the  good  Samaritan  of  the  wounded.  His 
disciples  have  always  proved  worthy  of  their  noble 
profession  when  engaged  on  the  field  of  battle.  They 
have  served  on  every  battlefield  without  any  prospect 
or  expectation  of  achieving  undying  fame,  or  even 
receiving  the  gratitude  due  them  from  those  benefited 
by  their  services.  Our  histories  of  the  world  bristle 
with  accounts  of  heroism  and  daring  exploits  of  fam- 
ous generals,  but  how  little  do  we  find  of  praise  of 
the  deeds  of  the  disciples  of  Esculapius  who  faced  all 
the  dangers  incident  to  warfare,  besides  doing  battle 
daily  with  the  Grim  Reaper  behind  the  fighting  line. 
The  Esculapians  on  the  field  of  battle  belong  to  a 
noble,  unselfish,  learned  profession.  It  requires  years 
of  hard  study  and  a  small  fortune  to  acquire  the  nec- 
essary knowledge  to  prepare  them  for  their  work. 
They  are  men  who  in  civil  life  would  occupy  a  high 
social  position  and  enjoy  a  handsome  income  from  the 
practice  of  their  profession.  But  the  medical  profes- 
sion of  all  countries  has  always  been  intensely  patri- 
otic in  times  of  war.  The  doctors  always  have  been 
and  always  will  be  the  salt  of  the  population.  Their 
education  and  training  are  of  a  nature  to  ensure  qual- 
ities necessary  to  citizenship  of  the  highest  type.  The 
practice  of  their  profession,  even  in  times  of  peace, 
is  admirably  adapted  to  prepare  them  for  the  emer- 
gencies of  war.  In  the  exercise  of  their  duties  they 
encounter  dangers  and  hardships  foreign  to  the  lives 
of  the  average  citizens.  They  brave  epidemics  far 
worse  than  bullets,  as  far  as  danger   to  life   is   con- 


258 

oerned,  without  fear  of  death.  In  cities  devastated 
by  the  scourge  of  yellow  fever  or  cholera,  when  every- 
body else  that  can  leaves  for  a  place  of  safety,  the 
doctors  remain  at  their  posts  and  minister  to  the  sick 
and  dying  without  any  expectation  of  a  substantial 
reward,  or  even  the  gratitude  of  their  impoverished 
clients.  Day  after  day  and  night  after  night  the 
familiar  modest  conveyance,  with  its  lonely  occupant, 
can  be  seen  in  the  depopulated  streets,  wending  its 
way  to  the  hovels  of  the  poor  on  its  errand  of  mercy. 

No  military  surgeon  has  ever  attained  the  fame  of 
the  innumerable  heroes  who  distinguished  themselves 
on  the  battlefield  and  whose  deeds  have  been  immor- 
talized in  prose  and  poetry.  In  rank,  pay  and  social 
position  he  has  always  been  at  a  disadvantage  as  com- 
pared with  the  leaders  of  armies.  His  greatest  reward 
always  has  been,  and  probably  always  will  be,  the 
consciousness  of  having  performed  his  duty  to  his 
fellow- men.  Will  you  not  agree  with  me  that  the 
doctrines  as  taught  by  Esculapius  and  as  practiced  by 
his  disciples  are  akin  to  the  teachings  of  the  Great 
Master?  If  you  do  not,  let  us  follow  for  one  day  and 
one  night  the  work  of  our  Esculapian  on  the  modern 
battlefield. 

The  disciple  of  Esculapius  is  on  the  field  before 
the  expected  battle.  He  is  a  non-combatant  and  mod- 
estly takes  his  place  behind  the  fighting  line.  He 
knows  what  is  expected  of  him  during  the  next  day, 
and  makes  the  necessary  preparations.  During  the 
night  the  troops  are  rushed  to  the  front  and  the  line 
of  battle  is  completed.  A  deadly  silence  attends  these 
preliminary  preparations  for  the  next  day's  conflict. 
From  the  commanding  general  down  to  the  private  a 
sense  of  responsibility,  uncertainty  and  suspense  pre- 
vails. With  the  dawn  of  the  new-born  day  the  deadly 
conflict  begins.  The  batteries  furnish  the  prelude  to 
the  impending  battle,  followed  by  the  irregular  firing 
of  the  picket  lines.  The  more  regular  cannonading 
on  both  sides  and  the  volleys  of  musketry  announce 
that   the   day's  bloody  work  has   begun  in   earnest. 


259 

The  uproar  and  tumult  of  battle  has  commenced.  The 
line  of  battle  is  advancing  slowly.  Our  Esculapian 
disciple  is  not  idle  for  any  length  of  time.  He  is  near 
enough  the  fighting  line  to  observe  the  movements  of 
the  troops,  and  within  range  of  the  fire.  The  singing, 
whizzing  bullets  do  not  disturb  his  calmness.  Shells 
plow  the  ground  around  and  about  him,  exploding 
with  a  dull  but  terrific  noise  and  sending  their  mes- 
sengers of  death  in  all  directions.  He  takes  position 
in  a  sheltered  place,  where  his  patients  will  find  pro- 
tection from  the  fire  of  the  enemy. 

He  is  hardly  ready  for  his  day's  work  when  the  first 
victim  arrives.  He  has  been  conveyed  to  the  rear  by 
friendly  hands.  A  hasty  examination  shows  that  he 
has  been  shot  through  the  thigh.  The  trousers  on 
the  injured  side  are  soaked  with  blood.  The  garment 
is  removed  and  a  stream  of  red  blood  locates  the  bul- 
let-wound. The  patient's  face  presents  a  deadly  pallor, 
his  forehead  is  covered  with  a  cold,  clammy  perspira- 
tion. The  hands  are  cold  and  the  pulse  at  the  wrist 
is  almost  imperceptible.  It  is  evident  that  the  bullet 
has  injured  a  large  blood-vessel  and  that  life  is  rapidly 
ebbing  away  from  hemorrhage.  The  patient  is  con- 
scious, but  passive  and  listless.  He  does  not  realize 
his  own  danger.  All  he  complains  of  is  a  torturing 
thirst  and  all  he  asks  for  is  a  drink  of  cold  water.  The 
experienced  eye  of  the  surgeon  takes  in  the  whole 
situation  at  a  glance.  He  knows  that  prompt  action 
is  necessary  to  ward  off  impending  death.  In  less 
time  than  is  necessary  to  describe  it,  he  applies  an 
elastic  constrictor  above  the  wound  which  arrests  the 
bleeding  promptly,  makes  use  of  the  first-aid  package 
to  protect  the  wound  against  infection,  administers 
the  necessary  restoratives,  pins  the  diagnosis  tag  to 
the  lapel  of  the  uniform,  satisfies  his  thirst  by  admin- 
istering the  contents  of  his  own  canteen,  and  hands 
the  patient  over  to  the  hospital-corps  men,  who  bring 
him  safely  to  the  ambulance  station. 

Before  he  has  disposed  of  his  first  charge  his  ser- 
vices are  urgently  demanded  in  his  immediate  vicinity. 


260 

and  he  hastens  to  the  new  scene  of  catastrophe.  A 
young  soldier  has  been  struck  down  by  a  fragment  of 
a  bursting  shell  which  has  almost  completely  severed 
both  legs  just  below  the  knee-joint.  The  patient  lies 
on  the  ground,  motionless,  with  his  sunken  eyes  di- 
rected stolidly  toward  the  overhanging  blue  sky.  He 
has  lost  but  little  blood,  but  his  lips  are  pale  and 
slightly  livid,  the  nostrils  dilated,  the  skin  of  the  fore- 
head thrown  into  deep  folds.  The  hands  are  cold  and 
the  pulse  at  the  wrist  can  not  be  felt. .  The  respira- 
tions are  irregular  and  sighing ;  a  long  and  deep  res- 
piration is  followed  by  a  number  of  shallow,  imper- 
fect expansions  of  the  chest.  The  mind  is  clear,  but 
it  takes  repeated  questions  to  elicit  the  simplest 
answer.  The  unearthly  brilliancy  of  the  otherwise 
expressionless,  staring  eyes  clearly  indicates  the  inev- 
itable doom  that  awaits  the  wounded  warrior.  His 
life  is  but  the  flickering  light  of  a  tallow  candle  to  be 
extinguished  at  any  moment.  The  surgeon  knows 
that  in  this  case  the  terrible  injury  will  result  in  death 
from  shock.  The  patient  is  ignorant  of  the  extent 
of  the  injury  sustained,  and  if  he  should  happen 
to  see  the  cold,  mangled,  motionless  legs,  almost 
detached  from  the  body,  he  would  not  realize  that 
his  life  is  in  such  immediate  jeopardy.  He  makes  no 
complaint  and  no  requests.  In  an  almost  inaudible 
whisper  he  may  ask  for  a  drink  of  water.  Home, 
relatives  and  friends  have  become  to  him  but  a  pleas- 
ant dream.  His  mind  is  occupied  by  the  experience 
of  the  day,  his  ears  are  filled  with  the  din  and  tumult 
of  battle,  his  eyes  are  still  resting  on  yonder  line  of 
battle  he  was  approaching  but  a  few  minutes  ago  with 
a  firm- hope  of  victory  when  he,  with  several  comrades, 
was  mowed  down  by  the  bursting  shell. 

The  conscientious  surgeon,  recognizing  the  hope- 
lessness of  the  case,  feels  that  he  has  another  mission 
to  perform.  He  ascertains  the  name  of  the  wounded 
and  of  the  nearest  relatives,  and  the  address,  and  then 
calmly  informs  his  patient  of  what  awaits  him.  For 
a  moment  such  information  brings  the  patient's  mind 


261 

back  to  realities  and,  probably  with  a  smile  and  look 
of  gratitude,  he  responds  calmly  to  the  questions.  He 
is  made  as  comfortable  as  can  be  done  under  the  cir- 
cumstances, but  before  the  setting  of  the  sun  his 
spirit  has  left  the  mutilated  body  and  joined  the 
peaceful  army  beyond  the  reach  of  human  warfare. 
The  next  mail  carries  with  it  a  letter  from  the  sur- 
geon, in  which  he  details  the  date  and  cause  of  death 
of  the  gallant  dead  to  his  distant  relatives.  What- 
such  letters  from  the  battlefield,  conveying  the  last 
message  of  the  dying  soldier,  mean  to  the  relatives, 
can  only  be  fully  realized  by  those  who  have  received 
them. 

As  the  heat  of  battle  rises  the  number  of  wounded 
increases  rapidly.  At  the  first  dressing  station  they 
are  lying,  sitting,  standing,  walking,  awaiting  the  first 
dressing.  Our  Esculapian  is  unmindful  of  the  heat, 
thirst  and  hunger,  and  hastens  from  soldier  to  soldier 
to  extend  to  as  many  as  possible,  and  in  the  shortest 
space  of  time,  the  blessings  of  the  modern  first-aid 
dressing. 

With  the  approaching  twilight  firing  gradually 
ceases,  without  any  definite  decision  of  the  fortunes 
of  war  on  either  side.  On  both  sides  the  soldiers  rest 
on  their  arms,  and  under  the  cover  of  darkness  satisfy 
hunger  and  thirst.  Tired  to  death  from  the  day's 
conflict,  sleep  overtakes  them  and  the  naked  earth  is 
coveted  as  a  luxurious  couch.  The  work  of  the  com- 
batants has  ceased  for  the  day;  that  of  the  non- 
combatants  now  begins  in  earnest.  Many  of  the 
wounded  still  remain  on  the  ground,  bleeding  and 
suffering  from  pain  and  thirst.  The  veil  of  darkness 
is  penetrated  in  all  directions  in  search  of  them.  The 
faint  voices  here  and  there  serve  a  useful  purpose  in 
locating  them.  The  dead  remain  where  death  reached 
them.  Many  a  litter-bearer's  steps  are  made  uncer- 
tain by  stumbling  over  the  corpses  which  cover  the 
field.  The  crowd  of  wounded  behind  the  fighting 
line,  at  the  ambulance  station  and  in  the  field  hospi- 
tals grows  larger  and  larger,  and  the  cries  for  surgical 


262 

aid  become  louder  and  more  and  more  imploring.  Can 
the  surgeon  who  has  worked  incessantly  all  day  quiet 
his  conscience  and  satisfy  nature's  demand  for  rest, 
follow  the  example  of  his  combatant  comrades,  throw 
himself  on  the  ground  and  seek  repose  by  surrender- 
ing himself  to  the  greatest  of  all  charmers — sleep? 
No!  As  long  as  his  brain  will  do  its  duty  and  as  long 
as  a  single  muscle  will  respond  to  his  determined  will 
power,  he  will  serve  the  wounded. 

There  are  cases  in  which  a  prompt  primary  opera- 
tion will  save  life.  These  are  the  cases  who  receive 
his  first  attention.  An  operating-table  is  extempo- 
rized, assistants  are  pressed  into  service,  and  with  the 
aid  of  a  candle  light  the  most  difficult  operations  are 
performed  in  the  silence  of  the  night,  broken  only  by 
the  frequent  moanings  of  the  numerous  wounded 
waiting  their  turn  for  the  operating  tent,  mingled 
from  time  to  time  with  the  shrieks  of  those  who  have 
become  raving  maniacs,  and  the  stertorous  breathing 
of  the  dying.  What  an  awful  night  for  our  poor 
Escalapian  who  forgets  his  own  wants  and  strains 
every  nerve  to  serve  his  fellow- men,  and  to  do  credit 
to  his  profession  and  the  country  and  flag  that  he 
calls  his  own.  Throughout  the  whole  night  he  works 
faithfully  and  incessantly,  and  with  the  break  of  day 
he  finds  his  task  still  unfinished,  and  the  prospects 
stare  him  in  the  face  of  a  repetition  of  the  previous 
day's  experience.  The  day  work  was  hard  and  trying; 
the  night  work  reached  the  limits  of  human  endurance. 

Can  you  give  me  a  more  striking  example  of  genu- 
ine patriotism  and  heroism  than  the  twenty-four  hours' 
work  performed  by  our  disciple  of  Esculapius  on  the 
field  of  battle?  If  you  can  not,  I  can.  It  iathe  same 
Esculapian  away  from  the  bloody  field  in  the  fever 
camp.  It  requires  courage  to  face  the  enemy  on  the 
field  of  battle.  It  requires  courage  to  stand  up  in  a 
rain  of  bullets  and  in  an  atmosphere  torn  asunder  every 
few  moments  by  shot  and  shell,  but  it  requires  more 
courage  to  enter  the  silent  fever  camp,  with  its  myri- 
ads of  invisible  foes.     The  song  of  the  bullet  is  sweet 


263 

music  compared  with  the  silent,  invisible  microbes 
that  cause  yellow  fever,  typhoid  fever,  malaria,  dysen- 
tery and  camp  diarrhea. 

It  is  a  privilege  to  die  a  glorious  death  on  the  battle- 
field; no  such  halo  of  glory  surrounds  the  death-bed 
in  the  fever  hospital.  It  is  here  that  the  greatest  deeds 
of  heroism  are  witnessed.  It  is  here  where  the  true 
manly  courage  of  our  Esculapian  hero  is  put  to  the 
severest  tests.  Let  me  ask  you  a  plain,  simple  ques- 
tion to  test  the  correctness  of  the  assertions  I  have 
made,  a  question  the  significance  of  which,  I  fear,  is 
not  fully  understood:  If  left  to  choose  for  yourself, 
would  you  not  be  more  willing  to  engage  in  a  battle 
than  to  live  and  work  in  a  camp  filled  with  typhoid  or 
yellow  fever  patients?  It  would  take  me  or  any  other 
disciple  of  Esculapius  not  long  to  decide  in  favor  of 
the  battlefield. 

During  the  war  just  ended,  the  disciples  of  Escula- 
pius have  taken  an  important  and  noble  part.  Cow- 
ardice is  unknown  in  our  medical  department.  Our  sur- 
geons have  done  their  duty  promptly  and  well.  Escu- 
lapius has  watched  their  conduct  and  their  acts.  On 
more  than  one  occasion  he  shook  his  massive  hoary 
head  in  disapproval,  not  because  of  what  they  did, 
but  of  what  they  could  not  do. 

Esculapius  has  drawn  his  own  conclusions  from  the 
lessons  of  the  war,  and  now  suggests  to  you  and  to 
the  people  of  the  United  States  and  their  representa- 
tives in  Congress  the  absolute  necessity  of  a  complete 
reorganization  of  the  Medical  Department.  He  insists 
that  the  rank  of  our  Surgeon-General  should  be  that 
of  a  Major-General,  that  he  should  be  clothed  with 
more  executive  power,  and  that  he  should  have  his. 
own  commissary  and  quartermaster's  departments.  He 
is  satisfied  if  these  important  changes  in  the  organi- 
zation of  the  Medical  Department  are  made,  that  there 
will  be  less  suffering  and  deaths  from  disease  should 
we  again  be  called  upon  to  cross  swords  with  another 
nation. 

In  conclusion,  permit  me  to  ask  you  to  listen  to  the 


264 

voice  of  Esculapius  in  your  efiPorts  to  efiPect  a  thor- 
ough reorganization  of  the  National  Guard.  The  new 
National  Guard  is  destined  to  become  the  bulwark  of 
the  fighting  force  of  our  country,  which  will  never 
imitate,  much  less  adopt,  the  militarism  of  the  totter- 
ing monarchies  of  the  old  world. 


NURSING  AND  NURSES   IN  WAR. 


One  of  the  grave  problems  of  modern  warfare  is 
the  proper  care  and  nursing  of  the  sick  and  wounded. 

Our  recent  experience  during  the  war  with  Spain 
has  brought  the  subject  prominently  to  the  attention 
of  the  military  authorities  and  the  people  of  the 
United  States.  The  war  just  ended  has  furnished 
the  most  instructive  and  forcible  object-lesson,  in 
demonstrating  the  importance  and  necessity  of  making 
adequate  preparation  for  the  proper  care  and  manage- 
ment of  the  disabled  soldiers  in  war  time.  The 
motives  which  precipitated  the  war  were  of  the  purest, 
noblest  kind,  arising  from  the  desire  to  bring  freedom 
and  liberty  to  the  legitimate  owners  of  our  neighbor- 
ing islands,  who,  under  the  iron  rule  of  an  effete,  bank- 
rupt monarchy,  had  been  deprived  of  their  liberty, 
happiness  and  prosperity  for  centuries.  On  our  part, 
the  war  spirit  was  aroused  by  a  sense  of  duty  to  our 
neighbors  and  to  advance  the  cause  of  humanity  on 
our  own  hemisphere,  and  not  for  gain  nor  conquest. 
It  is  not  strange  that  our  liberty-loving  people  re- 
sponded so  promptly  to  the  call  of  the  Chief  Executive 
for  volunteers.  It  required  no  special  foresight  to 
predict  with  certainty  that  a  war  with  Spain,  in  Cuba, 
would  result  in  greater  loss  of  life  and  suffering  from 
climate  and  disease  than  from  the  Spanish  bullets. 
The  result  of  the  war  has  shown  that  this  expectation 
has  been  fully  realized. 

The  short,  brilliant  campaign  on  land  and  sea  has 
taught  the  outside  world  the  strength  of  our  arms, 
and  resulted  in  a  victory  over  a  foreign  foe,  which  is 
well  calculated  to  stimulate  the  pride  and  patriotism 
for  our  government  and  its  various  departments  and 
institutions.     The  war  just  ended  was  characterized 


266 

by  the  humane  treatment  of  our  vanquished  enemy, 
and  the  desire  on  the  part  of  the  government  and  the 
people  to  provide  the  invading  army  with  all  the 
necessities  and  comforts  compatible  with  active  war- 
fare. The  war  cloud  came  upon  us  so  unexpectedly 
that  a  certain  amount  of  confusion  and  un prepared- 
ness in  the  management  of  the  campaign  had  to  be 
expected.  Considering  what  has  been  accomplished, 
we  have  every  reason  to  feel  grateful  that  the  prize 
secured  was  purchased  at  no  greater  cost  of  life  and 
suffering.  It  was  our  first  experience  in  fighting  a 
foreign  foe  in  a  foreign  land,  and  the  many  lessons 
taught  and  learned  will  prove  of  the  greatest  value 
should  we  again  be  called  to  cross  swords  with  a  nation 
beyond  the  limits  of  our  country.  Many  of  the  well- 
founded  complaints  of  the  management  of  the  war 
arose,  not  from  any  dereliction  of  duty  of  the  heads 
of  the  different  departments,  but  were  due  to  a  faulty 
organization,  and  this  is  particularly  true  of  the  med- 
ical department,  which  has  been  so  severely  criticised. 
The  executive  power  of  the  Surgeon -General  is  indeed 
an  extremely  limited  one.  Everything  of  importance 
has  to  pass  through  the  hands  and  by  sanction  of  the 
Secretary  of  War.  The  Secretary  of  War  is  a  busy 
man  in  keeping  track  of  what  is  going  on  in  his  de- 
partment outside  the  Surgeon- General's  office.  Again, 
the  medical  department  depends  entirely  on  the  quar- 
termaster's department  in  forwarding  and  distributing 
medical  and  hospital  supplies.  No  wonder  that  many 
collisions  between  these  departments  occurred  during 
the  war  with  Spain.  Oar  experience  has  taught  us  in 
a  most  forcible  way  that  the  medical  department 
should  have  charge  of  everything  pertaining  to  the 
care  of  the  sick  and  wounded,  in  order  to  accomplish 
that  for  which  it  is  intended.  The  Surgeon- General 
should  be  given  higher  rank  and  be  clothed  with  more 
executive  power,  to  enable  him  to  discharge  his  duties 
with  credit  to  himself  and  greater  benefit  to  those 
who  are  now  only  nominally  under  his  charge.  The 
Secretary  of  War  is  not  supposed  to  possess  much 


267 

knowledge  of  sanitation,  medicine  and  surgery,  or 
other  wants  of  the  sick  and  wounded,  and  yet  the 
Surgeon-General  is  powerless  in  the  execution  of  his 
orders  without  his  co-operation.  If  the  forwarding 
and  distribution  of  the  medical  and  hospital  supplies 
were  directly  under  the  control  and  management  of 
the  medical  department  we  would  have  heard  less  of 
criticism  regarding  the  scarcity  of  medicines  and 
hospital  supplies.  To  ma'ke  a  department  strong  and 
efficient  it  must  be  independent,  and  invested  with 
the  necessary  power  it  is  expected  to  wield,  and  charged 
with  a  corresponding  weight  of  responsibility. 

The  proper  care  of  the  sick  and  wounded  in  war  is 
a  subject  as  old  as  warfare  itself.  It  is  a  subject  that 
has  attracted  the  liveliest  interest  of  the  most  famous 
and  successful  commanders,  and  that  has  taxed 
severely  the  ingenuity  and  mental  resources  of  the 
most  famous  military  physicians.  The  soldier  who 
risks  his  life  in  the  defense  of  the  honor  of  his  coun- 
try, when  disabled  from  duty  by  wounds  or  disease,  is 
entitled  to  the  most  humane  treatment  and  the  best 
of  care  on  the  part  of  those  in  whose  charge  he  is 
placed.  The  moment  he  is  disabled  from  performing 
his  duty  he  comes  under  the  care  of  the  medical  de- 
partment, subject  to  its  rules  and  regulations.  The 
transportation  and  proper  care  of  the  sick  and  wounded 
are  under  the  management  of  the  medical  department. 
The  immensity  of  the  labor  which  devolved  upon  the 
Surgeon-General  and  his  limited  staff  of  assistants 
during  the  war  just  ended  must  become  apparent  to 
the  general  public,  when  we  consider  the  enormous 
number  of  the  sick  in  an  army  of  300,000  men  dis- 
tributed from  Porto  Rico  to  Manila— nearly  one- half 
the  circumference  of  the  globe.  Hundreds  of  the 
recently  enlisted  men  had  to  be  detailed  for  hospital 
duty  and  were  placed  in  charge  of  the  sick.  No  won- 
der that  among  so  many  some  proved  absolutely  use- 
less in  performing  the  trying  duties  of  an  army  nurse. 
Nursing  in  the  army  in  times  of  war  is  an  occupation 
which  is  always  attended  by  many  difficulties,  and 


•  268 

particularly  when  the  seat  of  war  is  in  a  foreign  coun- 
try. The  unrest  incident  to  the  mobilization  of  troops, 
the  moving  and  erection  of  hospital  tents,  the  limited 
facilities  for  cooking  and  often  for  working,  the  occa- 
sional overcrowding  of  the  allotted  hospital  space, 
the  uncerta^'nty  of  supplies,  are  some  of  the  incon- 
veniences which  the  army  nurse  must  expect  to 
meet  and  correct  as  far  as  lies  in  his  power  to  do  so. 
Patience,  obedience,  perseverance  and  devotion  to 
duty  are  a  few  of  the  most  essential  virtues  conducive 
to  satisfactory  and  successful  nursing  in  war.  The 
army  nurse,  from  the  very  beginning  of  his  philan- 
thropic career,  places  himself  beyond  the  reach  of  any 
glory  and  distinction  to  be  gained  on  the  battlefield. 
His  duties  are  more  arduous  and  taxing  than  those  of 
his  comrades  of  the  line.  Being  constantly  in  contact 
with  infectious  diseases  he  exposes  himself  to  more 
danger  than  on  the  battlefield.  It  requires  more 
courage  to  serve  in  a  yellow  fever  or  typhoid  fever 
hospital  than  to  face  the  enemy  on  the  battlefield. 
The  army  nurse,  with  his  inadequate  pay  and  no  rank, 
has  little  else  to  expect  but  a  full  measure  of  ingrati- 
tude. His  greatest  devotion  and  best  efforts  are  never 
fully  realized  and  appreciated.  If  he  is  competent 
and  devoted  to  his  work,  his  greatest  satisfaction  must 
consist  in  the  consciousness  of  duty  well  performed. 
He  is  a  Samaritan  in  every  sense  of  the  word,  whose 
sole  object  is  to  serve  his  disabled  combatant  comrades. 
Few  men  are  born  with  intrinsic  qualities  which  con- 
stitute an  efficient  successful  nurse.  A  true  nurse  is 
born,  not  made.  Most  male  nurses  lack  the  gentle- 
ness of  manner  and  touch  which  exercise  such  a  sooth- 
ing influence  over  the  fretful,  nervous,  impatient 
patient.  The  male  army  nurse  should  know  something 
about  cooking  to  enable  him  to  prepare  some  special 
palatable  dishes  for  the  sick — an  accomplishment 
which  but  few  can  claim.  To  utilize  the  ordinary 
army  rations  for  this  purpose  requires  tact  and  skill. 
It  is  wonderful  what  can  be  made  out  of  bacon,  beans, 
canned  meat,  hard  tack,  salt,  gpices  and  water  in  the 


269 

hands  of  one  skilled  in  the  preparation  of  special  diet. 
It  is  in  this  department  of  nursing  that  women  excel 
men  beyond  comparison. 

It  must  be  conceded  on  all  sides  that  the  nursing 
in  the  field  during  the  last  war,  as  well  as  during  any 
of  the  preceding  wars,   done  almost  exclusively  by 
male  nurses,  leaves  much  to  be  desired.     Many  of  the 
men  enlisted  for  this  special  purpose,  others  detailed 
from  the  line  for  the  hospital  corps,  lacked  entirely 
the  necessary   qualifications  by  nature  and  training 
for  such  an  important  and  responsible  position.     The 
haste  with  which   the  war  was  planned  and  finished 
precluded  the  possibility  of  making  a  careful  selection. 
The  tact  to  make  patients  comfortable  under  the  most 
adverse  circumstances  is'  rarely  found  in   men.     To 
anticipate  the  wishes  and  carry  out  the  directions  of 
the  attending  physicians,   requires  more  knowledge 
and  training  than  belonged  to  the  average  hospital- 
corps  men.     The  hospital-corps  men  of  the  volunteer 
forces,  mostly  new  men   in  the  service,  did  the  best 
they  could  under  the  circumstances,  but  their  work 
showed  a  decided  lack  of  discipline  and  special  train- 
ing  at  a  time  when  their  services  were  most  needed. 
With  additional  experience  many  of  them  would  come 
up  in  a  comparatively  short  time  to  the  standard  of 
requirements.     An  earnest  willingness  to  learn  and 
improve  must  be  accorded  to  most  of  them.     It  takes 
months  of  hard  work  to  make  a  soldier;  it  takes  a 
much  longer  time  to  make  a  good  nurse.     The  mem- 
bers of   the  hospital  corps  of   the  regular  army  are 
selected  with  great  care,  and  are  required  to  undergo 
a  thorough  and  systematic  course  of  instruction,  hence 
they  had  an  advantage  over  their  comrades  of  the  vol- 
unteer forces,  and  acquitted  themselves  more  satis- 
factorily in  the  discharge  of  their  duties.     But  every 
medical   ofiicer   is   conscious   of    the   fact  that  even 
many  displayed   shortcomings  which   were  too  con- 
spicuous to  be  easily  overlooked.     The  average  male 
nurse,  in  private,  as  well  as  in  military  life,  works  for 
money,  and  not  for  the  dignity  and  good    standing 


270 

of  his  profession,  or  the  welfare  of  his  fellowmen. 
The  sunny  side  of  the  hospital -corps  service  was  to 
be  found  in  the  transportation  of  the  sick  and  wounded. 
No  fighting  army  in  the  world  ever  enjoyed  better 
ambulance  facilities.  No  army  is  supplied  more  lib- 
erally  and  with  better  litters  and  ambulances  than  were 
in  use  during  the  recent  war  by  our  troops  at  home  and 
abroad;  and  no  better  or  more  efficient  men  could  be 
found  anywhere  than  those  who  were  j)laced  in  charge 
of  the  transfer  of  our  sick  and  wounded.  The  manner 
in  which  our  sick  were  conveyed  from  ambulance  to 
hospital  and  from  hospital  to  ambulance,  commanded 
the  attention  and  elicited  the  highest  praise  from  our 
foreign  visitors.  After  my  return  from  Porto  Rico, 
on  my  way  from  New  York  to  Montauk,  I  was  joined 
by  Lieutenant  Commander  Tomatsuri  of  the  Japanese 
naval  medical  service  and  two  staff  surgeons  of  the 
German  army,  who,  upon  arrival  at  the  camp,  watched 
with  the  greatest  interest  this  part  of  the  work  of  the 
hospital  corps.  One  of  the  German  surgeons  freely 
admitted  that  our  hospital  corps  men  were  far  more 
efficient  in  this  part  of  their  work  than  those  of  the 
German  army,  and,  what  commended  their  work  to 
him  the  most  was  the  gentleness  with  which  the 
patients  were  handled.  He  was  astonished  that  a 
hundred  or  more  patients  could  be  transferred  with- 
out hearing  a  rough  or  angry  word,  which  he  assured 
me  was  rather  the  exception  than  the  rule  in  the  Ger- 
man army.  Hospital  construction  as  witnessed  by 
these  distinguished  foreign  observers  of  our  war, 
during  the  early  history  of  Camp  Wikoff,  was  another 
source  of  surprise  and  admiration  to  them.  It  was 
difficult  for  them  to  comprehend  that  in  less  than 
three  weeks  excellent  hospital  accommodations  were 
furnished  for  nearly  two  thousand  patients.  I  doubt 
if  any  of  the  old  countries,  always  in  a  state  of  armed 
neutrality,  could  repeat  what  was  accomplished  by 
our  medical  department  in  this  direction.  Our  for- 
eign observers  will  never  forget  the  impressions  re- 
ceived in  Camp  Wikoff,  with  special  reference  to  the 


271 

transportation,  care  and  treatment  of  the  sick  of  our 
returning  army  from  Cuba.  Such  object-lessons  are 
best  calculated  to  impress  foreigners  with  the  magni- 
tude and  resources  of  our  country  and  the  patriotism 
of  our  people. 

A  new  phase  in  nursing  was  initiated  during  the 
last  war  by  the  use  of  hospital  ships.  The  medical 
department  of  the  Army  and  Navy  recognized  at  the 
proper  time  the  necessity  of  employing  ships  adapted 
for  the  transportation  of  disabled  soldiers  from  the 
seat  of  war  back  to  their  own  country,  where  they 
could  receive  better  care  and  nursing  and  escape  a 
prolonged  stay  in  a  malarial,  semi-tropic  country.  The 
hospital  ships  Relief,  Solace  and  Missouri  were  the 
means  of  saving  hundreds  of  lives  which,  without 
such  means  of  transportation,  would  have  perished  in 
Cuba  and  Porto  Rico.  The  horrors  enacted  on  some 
of  the  transports  are  more  than  balanced  by  the  com- 
forts, and  even  luxuries  the  sick  and  wounded  enjoyed 
on  these  floating  hospitals  on  their  homeward  jour- 
ney. Nothing  has  done  more  in  saving  life  and  allevi- 
ating suflPering  than  these  messengers  of  mercy  on 
their  hasty  errands  to  and  from  the  seat  of  war.  It 
was  on  these  vessels  that  the  nation's  patients  were 
in  the  care  of  competent  female  nurses.  Ask  any  of 
the  sick  soldiers  who  returned  on  any  of  these  ships, 
and  you  will  find  him  ready  to  praise  and  bless  the 
female  nurse  under  whose  care  he  was  placed  on  his 
return  from  the  seat  of  war.  He  will  always  remem- 
ber with  gratitude  her  gentleness  and  devotion  to 
the  sick  under  her  care.  During  the  four  trips  I 
made  on  the  hospital  ship  Relief,  to  and  from  Cuba 
and  Porto  Rico,  I  had  ample  opportunity  to  compare 
the  work  of  the  male  and  female  nurses,  and  I  have 
no  hesitation  in  speaking  in  decided  terms  in  favor 
of  the  latter.  Nursing  is  woman's  special  sphere. 
It  is  her  natural  calling.  She  is  born  a  nurse.  She 
is  endowed  with  all  the  qualifications,  mentally  and 
physically,  to  take  care  of  the  sick.  Her  sweet  smile 
and   gentle   touch   are  often  of  more  benefit  to  the 


272 

patient  than  the  medicine  she  administers.  The 
dainty  dishes  she  is  capable  of  preparing,  as  a  rule, 
accomplish  more  in  the  successful  treatment  of  dis- 
ease than  drugs.  Her  sense  of  duty  and  devotion 
to  those  placed  under  her  care  are  seldom  equaled 
by  men.  The  sick  soldier,  far  away  from  home,  rela- 
tives and  friends,  realizes  keenly  the  superiority  of 
female  over  male  nurses,  and  especially  so,  if  his 
illness  is  tinged,  as  is  often  the  case,  with  homesick- 
ness. It  is  under  such  circumstances  that  the  profes- 
sional female  nurse  is  greeted  in  camp,  on  board  ship 
and  in  the  hospital  as  an  angel  of  mercy,  and  every 
look  and  move  she  makes  are  of  the  keenest  interest 
to  the  expectant  sick.  For  the  time  being  she  takes 
the  place  of  the  deserted  wife,  the  loving  mother  or 
the  dear  sister  at  the  bedside.  She  watches  the 
progress  of  the  disease  by  day  and  by  night,  and 
her  heart  rises  and  gladdens  with  the  approach  of 
symptoms  denoting  improvement:  deep  sorrow  and 
tender  sympathy  take  possession  of  her  when,  in  spite 
of  all  her  exertions,  the  shadows  of  death  advance. 
Woman  is  the  natural  nurse,  and  nowhere  does  she 
appear  grander  or  nobler  than  when  she  is  minister- 
ing to  the  sick  and  dying  of  an  army  in  active  war- 
fare. The  American  woman,  above  those  of  any  other 
nation,  is  peculiarly  well  fitted  for  such  a  post  of 
duty.  She  is  enthusiastic,  energetic,  tireless,  devoted, 
and,  more  than  all  this,  intensely  patriotic.  Our  sick 
and  convalescent  soldiers  owe  a  lasting  debt  of  grati- 
tude to  the  small  army  of  female  nurses  who  left  their 
homes  with  no  expectations  of  pecuniary  gain  and 
served  their  country  in  camp  and  field,  in  fever- 
stricken  districts,  and  in  common  with  them,  suffered 
the  privations  incident  to  an  active  campaign  without 
a  word  of  complaint. 

The  demand  for  trained  nurses  during  the  war  with 
Spain  came  suddenly  and  rather  unexpectedly,  owing 
to  the  prevalence  of  typhoid  fever  in  the  National 
camps  and  later  by  the  return  of  the  sick  and  wounded 
from  Cuba  and  Porto  Rico.  From  the  very  beginning 


273 

of  the  war  the  Surgeon- General's  office  was  over- 
flooded  by  applications  for  service  in  the  hospitals 
from  all  parts  of  the  country.  The  material  to  select 
from  was  enormous,  but  the  task  of  making  a  careful 
selection  proved  to  be  a  difficult  one.  The  Surgeon- 
General  was  overburdened  with  the  various  details  of 
his  important  office  and  soon  found  it  impossible  to 
attend  to  this  part  of  his  duties  in  person  or  through 
his  assistants.  In  his  desire  to  supply  the  sick  with 
competent  nurses  he  assigned  this  duty  to  Dr.  Anita 
McGee  of  Washington,  who  was  commissioned  act- 
ting  assistant-surgeon,  probably  the  first  time  this 
honor  was  conferred  upon  a  woman  in  this  country. 
The  services  of  Dr.  McGee  proved  of  the  greatest  value 
in  selecting  from  the  thousands  of  applicants  a  suffi- 
cient number  of  trained,  competent  female  nurses  for 
duty  in  the  hospitals  at  different  points.  The  Amer- 
ican Red  Cross  Society  did  excellent  work,  not  only  in 
furnishing  supplies  of  all  kinds  where  and  when  they 
were  most  needed,  but  also  in  supplying  nurses  when 
emergencies  arose.  Miss  Clara  Barton,  the  Florence 
Nightingale  of  this  country,  president  of  the  society, 
has  performed  her  onerous  duties  during  the  entire 
war  with  a  devotion  and  earnestness  that  merit 
recognition  at  home  and  abroad.  She  has  been  tire- 
less in  her  efforts  to  bring  comfort  to  the  soldiers  at 
times  when  her  service  were  most  urgently  in  demand. 
The  State  of  Texas  and  the  little  steamer  Red  Cross, 
under  her  command,  made  their  appearance  at  Siboney 
at  a  time  when  outside  help  was  most  required.  Ice, 
medicines,  dressing  and  hospital  supplies  were  freely 
distributed  among  the  sick  and  wounded.  Miss  Bar- 
ton and  Mrs.  Porter,  wife  of  the  secretary  of  the  Pres- 
ident, went  to  the  front,  a  distance  of  eight  miles,  over 
one  of  the  roughest  roads  imaginable,  in  an  army 
wagon,  and  extended  the  work  of  the  Red  Cross  to  the 
very  trenches  before  Santiago.  A  female  nurse  and 
a  number  of  male  helpers  ministered  to  the  sick  in 
the  Division  Hospital  in  charge  of  Major  Wood.  I 
found  representatives  of  the  Red  Cross  in  El  Caney, 


274 

in  the  vestry  of  the  old  village  church,  dealing  out 
hardtack  and  flour  to  the  hungry  crowds  of  refugees. 
After  the  surrender  of  Santiago  the  State  of  Texas 
was  the  first  vessel  to  enter  its  harbor  on  its  errand  of 
mercy  in  bringing  food  for  the  hungry  Cubans,  and 
medicines  and  delicacies  for  the  sick  of  the  victorious 
and  vanquished  armies.  The  Red  Cross  Society 
established  supply  depots  in  all  of  the  large  camps, 
and  the  good  work  done  everywhere  will  live  in  the 
memories  of  all  who  were  engaged  in  the  conflict.  I 
was  told  by  a  representative  of  this  society  that  in 
Montauk  alone  for  a  number  of  weeks,  supplies  to  the 
amount  of  $2000  were  distributed  daily.  The  Red 
Cross  female  nurses  at  Siboney  did  heroic  work  when 
the  sick  and  wounded  of  our  army  were  in  the  great- 
est distress.  Several  of  these  nurses  were  among  the 
first  of  the  yellow  fever  victims,  and  had  to  be  taken 
to  the  first  hospital  for  treatment.  The  sick  and 
wounded  Spanish  prisoners  at  Siboney  were  almost 
exclusively  cared  for  by  the  Red  Cross. 

Miss  Barton  has  the  confidence  of  the  American 
people,  and  she  has  sustained  it  through  the  present 
war  by  the  thoughtful  and  timely  distribution  of  the 
innumerable  and  liberal  donations  to  the  society  she 
so  well  represents.  After  peace  was  declared,  Miss 
Clara  Barton  immediately  sailed  for  Havana  to  bring 
much-needed  aid  to  the  starving  reconcentrados  of  the 
long-besieged  city,  while  her  numerous  helpers  con- 
tinued their  faithful  work  in  the  home  camps.  The 
work  of  the  Red  Cross  received  the  moral  and  sub- 
stantial support  of  the  charitably  disposed  citizens 
throughout  the  United  States,  and  liberal  donations 
from  abroad.  Recent  experience  has  again  demon- 
strated that  this  society  is  the  most  important  auxil- 
iary in  war  as  well  as  other  National  disasters  in  bring- 
ing prompt  relief  to  the  sufferers.  It  seems  to  me 
that  the  Red  Cross  Society  is  the  proper  organization 
from  which  to  recruit  the  nursing  force  should  we  be 
confronted  by  another  war.  This  society  should  be 
made  stronger  and  extend  its  influence  to  every  part 


275 

of  the  country.  Under  the  supervision  of  its  repre- 
sentatives, educated,  trained  nurses  should  receive  ad- 
ditional training  preparing  them  for  military  service 
and  other  emergency  work.  A  list  of  names  of  nurse% 
who  had  satisfied  the  proper  authorities  of  their  spe- 
cial proficiency  for  this  kind  of  work  should  be  kept, 
and  the  selection  made  from  it,  should  a  request  be 
made  by  the  medical  department  for  service  in  the 
army.  Provision  for  comiDetent  male  nurses  for  army 
duty  should  be  made  by  a  more  thorough  training  of 
the  hospital  corps  of  the  National  Guard  of  the  States, 
a  much  neglected  subject  west  of  the  Alleghany 
mountains.  In  addition  to  this,  it  would  be  advisa- 
ble to  establish  training  schools  for  young  men  in  the 
principal  cities  of  the  United  States,  on  the  same  plan 
and  for  the  same  purpose  as  the  Samaritan  organiza- 
tions in  Germany.  The  training  of  such  men  should 
be  of  the  most  practical  nature,  including  the  trans- 
portation of  the  sick  and  wounded,  first-aid  dressing, 
the  art  of  nursing  and  cooking,  with  special  reference 
to  diet  for  the  sick.  An  education  of  this  kind  would 
be  of  the  greatest  value  and  profit  to  the  pupils  as 
well  as  the  respective  communities,  and  would  be  the 
means  of  furnishing  desirable  material  for  the  hospi- 
tal corps  in  case  of  war  and  efficient  aid  in  case  of  ac- 
cidents and  National  catastrophies  necessitating  a  sud- 
den call  for  competent  nurses.  It  appears  to  me  that 
such  a  school  of  instruction  for  Samaritans  could  be 
made  attractive  and  interesting  to  the  pupils,  and 
would  become  a  reliable  source  from  which  to  make 
selections  for  army  nurses  and  the  hospital  corps. 

The  Sisters  of  Charity  stood  in  the  front  rank  of 
volunteer  nurses  in  the  Spanish  war  as  well  as  in 
nearly  all  of  the  great  wars  during  the  last  two  hun- 
dred years.  It  is  the  oldest  and  best  working  order 
in  the  Catholic  church.  President  McKinley  became 
familiar  with  their  efficient  and  faithful  services  dur- 
ing the  Civil  War  and  gladly  accepted  the  offer  of  the 
Order  to  furnish  nurses,  made  soon  after  the  war  broke  . 
out.     All  of  the  principal  hospitals  in  charge  of  the 


276 

Sisters  of  Charity  sent  representatives  to  the  front. 
They  were  on  duty  in  nearly  all  of  the  National  camps 
in  Cuba  and  Porto  Rico.  The  first  six  sisters  were 
•ent  to  the  Naval  Hospital,  Portsmouth,  Va.,  July  16. 
The  whole  number  of  sisters  on  duty  September  24 
was  232.  The  annex  and  the  surgical  wards  and  oper- 
ating tent  at  Montauk  were  exclusively  in  charge  of 
100  members  of  the  order.  Their  work  in  that  great 
camp  was  a  source  of  gratification  to  and  admiration 
by  the  medical  officers  and  all  of  the  visitors  and 
relatives  of  the  sick.  Several  of  these  brave  sisters 
have  gone  to  their  final  reward  in  the  service  of  their 
country,  others  are  lying  dangerously  ill  in  the  differ- 
ent hospitals.  Too  much  can  not  be  said  in  praise  of 
this  noble  order,  as  it  has  always  made  itself  felt  in  a 
modest  but  most  efficient  way  in  all  of  the  great  wars, 
without  regard  to  nationality  or  creed  of  the  contend- 
ing armies. 

Among  the  distinguished  lay  nurses  special  men- 
tion must  be  made  of  Miss  Chanler  of  New  York.'  I 
met  Miss  Chanler  in  Ponce,  Porto  Rico,  where  she 
did  most  excellent  service  in  the  military  hospitals. 
Her  numerous  patients  will  always  remember  with 
deepest  gratitude  her  arduous,  unselfish  work.  The 
Misses  Wheeler,  daughters  of  Major-General  Wheeler, 
accompanied  their  heroic  father  to  Cuba,  nursed  him 
when  he  was  ill  and  labored  earnestly  among  the  sick 
of  his  command.  They  continued  their  labor  of  love 
at  Camp  Wikoff,  where  many  a  sick  soldier  owed  his 
restoration  to  health  to  their  unremitting,  tender  care. 
Diet  kitchens  were  established  at  Camp  Wikoff  under 
the  supervision  of  Mrs.  M.  H.  Willard  of  New  York, 
which  proved  of  the  greatest  benefit  for  the  sick  and 
convalescent  soldiers.  I  take  the  liberty  to  quote 
from  a  letter  recently  received  from  Mrs.  Willard, 
dealing  with  this  subject:  "For  six  weeks  I  was  at 
Montauk,  representing  the  Red  Cross  Society  Main- 
tenance of  Trained  Nurses,  which,  together  with  the 
Massachusetts  Volunteer  Aid  Association,  established 
diet   kitchens   in  connection  with   the  General  and 


277 

Division  Hospitals.  On  my  arrival  at  Camp  Wikoff 
I  found  the  kitchen  department  in  a  very  serious  con- 
dition. The  officers,  doctors,  nurses,  orderlies  and 
employees,  as  well  as  the  patients,  were  procuring 
their  food  from  a  small  wooden  building,  presided 
over  by  an  army  cook,  and  everything  in  and  around 
the  mess  hall  was  in  a  dirty  condition.  Eice  and  oat- 
meal were  the  principal  diet  for  the  sick,  and  this  w^as 
so  often  burned  and  badly  cooked  that  the  patients 
were  unable  to  relish  or  retain  it.  The  first  diet 
kitchen  was  established  August  27,  and  those  at  the 
three  Division  Hospitals  soon  followed,  and  this,  with 
one  at  the  Detention  Hospital,  made  a  system  of  five 
kitchens,  covering  a  radius  of  three  miles,  with  a  force 
of  fifteen  cooks,  several  dieticians,  ten  volunteers  and 
twelve  detailed  men.  These  kitchens  supplied  care- 
fully and  scientifically  prepared  food  for  the  sick  and 
convalescent,  and  the  physicians  and  nurses  were  able 
to  procure  for  their  patients,  not  only  liquid  diets,  but 
light  and  special  diets  as  well.  One  of  our  prominent 
physicians  remarked  that  his  patients  were  better  fed 
at  Camp  Wikoff  than  in  any  hospital  in  New  York 
City  with  which  he  had  been  connected.  The  Gov- 
ernment soon  realized  the  value  of  the  work,  and  two 
weeks  after  the  opening  of  the  kitchens  they  were 
turned  over  to  the  officials,  and  from  that  time,  with 
no  cost  to  private  enterprise,  the  sick  soldiers  of  all 
the  hospitals  were  served,  not  only  with  home-made 
broths  of  beef,  mutton  and  chicken,  but  also  with 
oysters,  broiled  chicken,  tenderloin  steaks,  chops,  jel- 
lies, custards,  etc." 

This  new  enterprise  in  caring  for  sick  soldiers  de- 
serves to  be  brought  to  the  attention  of  the  general 
public  and  should  receive  the  strongest  encouragement 
in  the  event  of  another  war. 

The  different  relief  societies,  National,  State  and 
local,  did  noble  work  in  aiding  the  Government  in 
properly  caring  for  the  sick  and  wounded.  The  names 
of  Miss  Helen  Gould,  Mrs.  Ellen  Hardin  Walworth, 
and  scores  of  other  noble-minded,  patriotic  women 


Z<i 


will  always  be  prominently  mentioned  in  the  history 
of  the  short,  decisive  war  so  gloriously  ended.  The 
charity  that  has  been  practiced  so  boautifully  and  so 
generally,  must  satisfy  our  victorious  army  that  the 
patriotism  they  can^ied  into  the  field  has  been  culti- 
vated at  home  in  words  and  action  to  a  degree  and 
extent  unparalleled  in  the  history  of  the  world.  War 
in  a  just  cause  begets  patriotism,  and  nothing  can 
demonstrate  this  more  clearly  and  forcibly  than  our 
experience  in  the  field  and  at  home  during  the  last 
eventful  six  months. 


Los  Angeles 
This  book  is  DUE  on  the  last  date  stamped  below. 


JUN13  73 
2WKSFR5MRECPPT 

MAR    9  TO 

RECEIVED 

MAR  3 1 1989 

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